Provider Demographics
NPI:1265797955
Name:OWENS, THERESA ANN (COTA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6732
Mailing Address - Country:US
Mailing Address - Phone:636-625-1005
Mailing Address - Fax:
Practice Address - Street 1:1998 HANLEY RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6732
Practice Address - Country:US
Practice Address - Phone:636-625-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant