Provider Demographics
NPI:1790918365
Name:OWEN, MEGAN KURTZ
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:KURTZ
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-6200
Mailing Address - Fax:415-749-1433
Practice Address - Street 1:100 ROWLAND WAY STE 205
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5041
Practice Address - Country:US
Practice Address - Phone:415-600-6200
Practice Address - Fax:415-749-1433
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT15408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235565OtherBOARD CERTIFICATION
CA15408OtherSTATE MEDICAL LICENSE