MEDICARE: MRS. JENA COWAN MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT004209	GA

General Provider Information

NPI Number	:	1558670562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENA COWAN MS, OTR/L

Provider Business Mailing Address
First Line	:	2442 SUWANEE POINTE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-1329
Country	:	US
Telephone Number	:	678-634-3246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2442 SUWANEE POINTE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-1329
Country	:	US
Telephone Number	:	678-634-3246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2010
Last Update Date	:	09/26/2010

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