Provider Demographics
NPI:1679824502
Name:OWEN, JENNIFER CAROL (MOT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL
Last Name:OWEN
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4541
Mailing Address - Country:US
Mailing Address - Phone:503-575-9402
Mailing Address - Fax:844-234-8735
Practice Address - Street 1:1425 N KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4541
Practice Address - Country:US
Practice Address - Phone:503-575-9402
Practice Address - Fax:844-234-8735
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR297470225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist