Provider Demographics
NPI:1386424315
Name:MAURO, COURTNEY JUNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:JUNE
Last Name:MAURO
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 1:444 ELDORA DR
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32759-9328
Mailing Address - Country:US
Mailing Address - Phone:704-657-8021
Mailing Address - Fax:
Practice Address - Street 1:6520 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5703
Practice Address - Country:US
Practice Address - Phone:321-622-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT24653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist