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General NPI Number Information
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NPI Number | 1598858771
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Entity Type | Individual
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Provider Name | MARTHA COWAN OTRL
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 3519 S BAILEYVILLE RD
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City | FREEPORT
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State | IL
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Zip | 61032-9731
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Country | US
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Telephone | 815-541-7740
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Fax | 815-232-8763
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Provider Business Mailing Address
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Address Line | 1341 EMPIRE CT
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City | FREEPORT
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State | IL
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Zip | 61032
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Country | US
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Telephone | 815-541-7740
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Fax | 815-232-8763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056000666
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License Number State | IL
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