Provider Demographics
NPI:1689912297
Name:OWENS, STEPHANIE N
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:N
Last Name:OWENS
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 1:201 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-4030
Mailing Address - Country:US
Mailing Address - Phone:765-662-9905
Mailing Address - Fax:765-613-0108
Practice Address - Street 1:201 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-4030
Practice Address - Country:US
Practice Address - Phone:765-662-9905
Practice Address - Fax:765-613-0108
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004527A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant