Provider Demographics
NPI:1366985202
Name:HOGAN, COURTNEY NOEL (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NOEL
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SEVEN ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-2508
Mailing Address - Country:US
Mailing Address - Phone:314-719-7980
Mailing Address - Fax:
Practice Address - Street 1:13550 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5812
Practice Address - Country:US
Practice Address - Phone:314-878-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016031420225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology