Provider Demographics
NPI:1053199661
Name:CROOKS, COURTNEY GRANT (MOTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRANT
Last Name:CROOKS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-4456
Mailing Address - Country:US
Mailing Address - Phone:318-419-6675
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6409
Practice Address - Country:US
Practice Address - Phone:318-691-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist