Provider Demographics
NPI:1073095725
Name:OWENS, AMANDA C (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:OWENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 OBSIDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1160
Mailing Address - Country:US
Mailing Address - Phone:601-421-1464
Mailing Address - Fax:
Practice Address - Street 1:1900 N FRANCES ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-1215
Practice Address - Country:US
Practice Address - Phone:972-524-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213470224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty