Provider Demographics
NPI:1417469396
Name:FEAGINS, COURTNEY ANNE BONO (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE BONO
Last Name:FEAGINS
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANNE
Other - Last Name:VANSKIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:405 E BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3122
Mailing Address - Country:US
Mailing Address - Phone:641-226-4602
Mailing Address - Fax:
Practice Address - Street 1:405 E BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3122
Practice Address - Country:US
Practice Address - Phone:641-226-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist