Provider Demographics
NPI:1093488918
Name:OWENS, CVITA N (COTA)
Entity Type:Individual
Prefix:MS
First Name:CVITA
Middle Name:N
Last Name:OWENS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:CVITA
Other - Middle Name:N
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:6100 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2469
Mailing Address - Country:US
Mailing Address - Phone:219-427-0196
Mailing Address - Fax:219-427-0197
Practice Address - Street 1:6100 MILLER AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2469
Practice Address - Country:US
Practice Address - Phone:219-427-0196
Practice Address - Fax:219-427-0197
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002535A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics