Provider Demographics
NPI:1447589775
Name:MACGOWN, SACHA R
Entity type:Individual
Prefix:
First Name:SACHA
Middle Name:R
Last Name:MACGOWN
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 1:902 SGT JOHN A PITTMAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-7343
Mailing Address - Country:US
Mailing Address - Phone:662-453-9173
Mailing Address - Fax:662-455-4933
Practice Address - Street 1:902 SGT JOHN A PITTMAN DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-7343
Practice Address - Country:US
Practice Address - Phone:662-453-9173
Practice Address - Fax:662-455-4933
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist