Provider Demographics
NPI:1598858771
Name:COWAN, MARTHA (OTRL)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 EMPIRE CT
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032
Mailing Address - Country:US
Mailing Address - Phone:815-541-7740
Mailing Address - Fax:815-232-8763
Practice Address - Street 1:3519 S BAILEYVILLE RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-9731
Practice Address - Country:US
Practice Address - Phone:815-541-7740
Practice Address - Fax:815-232-8763
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist