Provider Demographics
NPI:1427649342
Name:HOGAN, COURTNEY DENSON (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DENSON
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 1:1014 LUNSFORD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1948
Mailing Address - Country:US
Mailing Address - Phone:980-621-4943
Mailing Address - Fax:
Practice Address - Street 1:6200 ROBERTA RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8418
Practice Address - Country:US
Practice Address - Phone:704-459-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist