Provider Demographics
NPI:1083962179
Name:OWENS, KIM WRIGHT (L/OTR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:WRIGHT
Last Name:OWENS
Suffix:
Gender:F
Credentials:L/OTR
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LASHON
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:L/OTR
Mailing Address - Street 1:4910 AIRPORT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-238-1800
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:4910 AIRPORT AVE
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-238-1800
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110654225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist