Provider Demographics
NPI:1215392121
Name:GOWEN, JANICE REID (707)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:REID
Last Name:GOWEN
Suffix:
Gender:F
Credentials:707
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 N 68TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2117
Mailing Address - Country:US
Mailing Address - Phone:402-572-2134
Mailing Address - Fax:
Practice Address - Street 1:6809 N 68TH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2117
Practice Address - Country:US
Practice Address - Phone:402-572-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE707224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant