Healthcare Provider Details

I. General information

NPI: 1194930438
Provider Name (Legal Business Name): AMY OWENS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY GUSTAFSON OTR

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/27/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21901 S VICTORY RD APT A
SPRING HILL KS
66083-9615
US

IV. Provider business mailing address

23975 CLARE ROAD
PAOLA KS
66071-4016
US

V. Phone/Fax

Practice location:
  • Phone: 913-357-5381
  • Fax: 913-222-1912
Mailing address:
  • Phone: 913-963-8113
  • Fax: 913-963-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-00649
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: