Individual
COURTNEY LEE MODESITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,OT
Contact information
Practice address
634 TOMMY AARON DR, GAINESVILLE, GA 30506-1504
(770) 503-7337
(770) 503-7337
Mailing address
634 TOMMY AARON DR, GAINESVILLE, GA 30506-1504
(770) 503-7337
(770) 503-7337
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT004984
GA
Other
Enumeration date
03/26/2010
Last updated
03/26/2010
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