Provider Demographics
NPI:1316154388
Name:OWEN, GWYNETH (OTRL CHT)
Entity type:Individual
Prefix:MISS
First Name:GWYNETH
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ALLEN ROAD
Mailing Address - Street 2:UNIT 118
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4079
Mailing Address - Country:US
Mailing Address - Phone:802-734-3781
Mailing Address - Fax:
Practice Address - Street 1:192 TILLEY DRIVE
Practice Address - Street 2:ORTHOPEDIC SPECIALTY CENTER
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-847-8911
Practice Address - Fax:802-847-8499
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0069391225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand