Provider Demographics
NPI:1689886855
Name:COWGILL, AMY LEE (BA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:COWGILL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13481 W MCDOWELL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2720
Mailing Address - Country:US
Mailing Address - Phone:235-362-3256
Mailing Address - Fax:
Practice Address - Street 1:13481 W MCDOWELL RD STE 300
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2720
Practice Address - Country:US
Practice Address - Phone:235-362-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564710Medicaid