Provider Demographics
NPI:1588718472
Name:DICKINSON, COURTNEY ONNOLEE (OT/L)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ONNOLEE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6663
Mailing Address - Country:US
Mailing Address - Phone:910-313-2111
Mailing Address - Fax:919-928-9423
Practice Address - Street 1:1911 S 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6663
Practice Address - Country:US
Practice Address - Phone:910-313-2111
Practice Address - Fax:919-928-9423
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5543225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301787Medicaid