Provider Demographics
NPI:1730790759
Name:COWAN, SONJA RENEE
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:RENEE
Last Name:COWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FOREMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71836-8980
Mailing Address - Country:US
Mailing Address - Phone:903-826-3801
Mailing Address - Fax:
Practice Address - Street 1:1006 1ST ST
Practice Address - Street 2:
Practice Address - City:FOREMAN
Practice Address - State:AR
Practice Address - Zip Code:71836-8980
Practice Address - Country:US
Practice Address - Phone:903-826-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR965225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics