Healthcare Provider Details

I. General information

NPI: 1740075209
Provider Name (Legal Business Name): HEATHER NICOLE MCCOWN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SW 9TH AVE
AMARILLO TX
79106-4162
US

IV. Provider business mailing address

5500 SW 9TH AVE
AMARILLO TX
79106-4162
US

V. Phone/Fax

Practice location:
  • Phone: 806-352-7244
  • Fax:
Mailing address:
  • Phone: 806-290-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number122589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: