Healthcare Provider Details

I. General information

NPI: 1093680332
Provider Name (Legal Business Name): EMMALINE OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S 3RD ST
ODESSA MO
64076-1453
US

IV. Provider business mailing address

30882 HIGHWAY NN
BLACKBURN MO
65321-2007
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2025040842
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: