Provider Demographics
NPI:1902119191
Name:OWENS, MICHELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E WALKER ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8954
Mailing Address - Country:US
Mailing Address - Phone:662-862-6140
Mailing Address - Fax:662-862-6143
Practice Address - Street 1:907 E WALKER ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8954
Practice Address - Country:US
Practice Address - Phone:662-862-6140
Practice Address - Fax:662-862-6143
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA2286224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant