Provider Demographics
NPI:1174740468
Name:SEBASTIAN, COURTNEY DENISE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DENISE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DENISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1659 MUNROE FALLS AVE
Mailing Address - Street 2:APT. 35
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3660
Mailing Address - Country:US
Mailing Address - Phone:330-475-4191
Mailing Address - Fax:
Practice Address - Street 1:1659 MUNROE FALLS AVE
Practice Address - Street 2:APT. 35
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3660
Practice Address - Country:US
Practice Address - Phone:330-475-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482335Medicaid