Provider Demographics
NPI:1629101373
Name:COWDER, NANCY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:COWDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:RR 2 BOX 346
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-9545
Mailing Address - Country:US
Mailing Address - Phone:570-286-1869
Mailing Address - Fax:570-538-1015
Practice Address - Street 1:245 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-1033
Practice Address - Country:US
Practice Address - Phone:570-538-2561
Practice Address - Fax:570-538-1015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-006875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist