Provider Demographics
NPI:1699435867
Name:DOTSON, COURTNEY PAGE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PAGE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 RED JACKET ROW
Mailing Address - Street 2:
Mailing Address - City:MATEWAN
Mailing Address - State:WV
Mailing Address - Zip Code:25678
Mailing Address - Country:US
Mailing Address - Phone:606-385-0353
Mailing Address - Fax:
Practice Address - Street 1:84 RED JACKET ROW
Practice Address - Street 2:
Practice Address - City:MATEWAN
Practice Address - State:WV
Practice Address - Zip Code:25678-2567
Practice Address - Country:US
Practice Address - Phone:606-385-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant