Healthcare Provider Details

I. General information

NPI: 1972811305
Provider Name (Legal Business Name): KRISTEN OWENS MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E COUNTY LINE RD SUITE E
RIDGELAND MS
39157-1928
US

IV. Provider business mailing address

199 BROOKMOORE DRIVE
COLUMBUS MS
39705
US

V. Phone/Fax

Practice location:
  • Phone: 601-853-9747
  • Fax: 601-898-4761
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2319
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: