Provider Demographics
NPI:1962265843
Name:OWENS, KACIE D (LMT, MTI)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:D
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMT, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10252 W ADAMS AVE STE 104A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5849
Mailing Address - Country:US
Mailing Address - Phone:254-780-6344
Mailing Address - Fax:
Practice Address - Street 1:10252 W ADAMS AVE STE 104A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5849
Practice Address - Country:US
Practice Address - Phone:254-780-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist