Provider Demographics
NPI:1306952684
Name:MCLAUGHLIN, COURTNEY LYNN (OTRL)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4013
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:
Practice Address - Street 1:122 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4013
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT00003177OtherOCCUP THERAPY LICENSE #
WA0227851OtherLABOR AND INDUSTRIES
WAG8870005OtherMEDICARE LEGACY
WA8870005Medicare PIN