Basic Information
| Provider Information | |||||||||
| NPI: | 1346674462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8365 WOODLAND FERRY RD | ||||||||
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| City: | LAUREL | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199563851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023819274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 E KING ST | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026283000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | JT-0000871 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.