Provider Demographics
NPI:1508171323
Name:OWENS, CORRINE NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:NICOLE
Last Name:OWENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 CATTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8083
Mailing Address - Country:US
Mailing Address - Phone:507-273-0849
Mailing Address - Fax:
Practice Address - Street 1:650 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9348
Practice Address - Country:US
Practice Address - Phone:715-684-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103947225X00000X
WI4923-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty