Individual
ELIJAH OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
247 WILLIS HIDE A WAY, HAYSI, VA 24256-6361
(276) 219-4295
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131000956
VA
224Z00000X
Occupational Therapy Assistant
Primary
2289
TN
Other
Enumeration date
05/14/2016
Last updated
05/14/2016
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