MEDICARE: OWLS THERAPY, LLC

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	235Z00000X	Speech-Language Pathologist	2202006249	VA

General Provider Information

NPI Number	:	1861980716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWLS THERAPY, LLC

Provider Business Mailing Address
First Line	:	2776 S ARLINGTON MILL DR # 546
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3402
Country	:	US
Telephone Number	:	858-699-5638
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 S ARLINGTON MILL DR # 546
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3402
Country	:	US
Telephone Number	:	858-699-5638
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JANENE N BESCH
Credential	:	MA, CCC-SLP
Telephone Number	:	858-699-5638

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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