Healthcare Provider Details

I. General information

NPI: 1508254608
Provider Name (Legal Business Name): JORDAN LEE TOWERY OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 HAYDEN BRIDGE RD
OWENSBORO KY
42301-8527
US

IV. Provider business mailing address

2411 HAYDEN BRIDGE RD
OWENSBORO KY
42301-8527
US

V. Phone/Fax

Practice location:
  • Phone: 270-929-2332
  • Fax:
Mailing address:
  • Phone: 270-929-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number163900
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: