Provider Demographics
NPI:1508254608
Name:TOWERY, JORDAN LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:TOWERY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 HAYDEN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8527
Mailing Address - Country:US
Mailing Address - Phone:270-929-2332
Mailing Address - Fax:
Practice Address - Street 1:2411 HAYDEN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8527
Practice Address - Country:US
Practice Address - Phone:270-929-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163900225X00000X
KY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist