Provider Demographics
NPI:1194930438
Name:OWENS, AMY (OTR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:23975 CLARE ROAD
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-4016
Mailing Address - Country:US
Mailing Address - Phone:913-963-8113
Mailing Address - Fax:913-963-8113
Practice Address - Street 1:21901 S VICTORY RD APT A
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-9615
Practice Address - Country:US
Practice Address - Phone:913-357-5381
Practice Address - Fax:913-222-1912
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26818026OtherBCBS OF KANSAS CITY