Healthcare Provider Details

I. General information

NPI: 1689886855
Provider Name (Legal Business Name): AMY LEE COWGILL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13481 W MCDOWELL RD STE 300
GOODYEAR AZ
85395-2720
US

IV. Provider business mailing address

13481 W MCDOWELL RD STE 300
GOODYEAR AZ
85395-2720
US

V. Phone/Fax

Practice location:
  • Phone: 235-362-3256
  • Fax:
Mailing address:
  • Phone: 235-362-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: