Provider Demographics
NPI:1760737225
Name:MCGOWIN, CARA S (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:S
Last Name:MCGOWIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:CARA
Other - Middle Name:S
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1621 NORTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6451
Mailing Address - Country:US
Mailing Address - Phone:573-893-5315
Mailing Address - Fax:
Practice Address - Street 1:3108 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4918
Practice Address - Country:US
Practice Address - Phone:573-634-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty