Healthcare Provider Details

I. General information

NPI: 1467082800
Provider Name (Legal Business Name): AMANDA PERDUE OWEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N LOY LAKE RD STE J
SHERMAN TX
75090-2837
US

IV. Provider business mailing address

PO BOX 1466
POTTSBORO TX
75076-1466
US

V. Phone/Fax

Practice location:
  • Phone: 903-487-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number113424
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number113424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: