Provider Demographics
NPI:1962495309
Name:COURTEMANCHE, COURTNEY SILL (ATC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SILL
Last Name:COURTEMANCHE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 FAIRBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1053
Mailing Address - Country:US
Mailing Address - Phone:301-367-0963
Mailing Address - Fax:
Practice Address - Street 1:6213 FAIRBOURNE CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1053
Practice Address - Country:US
Practice Address - Phone:301-367-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
070002085OtherBOARD OF CERTIFICATION, INC.