Healthcare Provider Details

I. General information

NPI: 1750060216
Provider Name (Legal Business Name): ELIZABETH LAYNE BOWDEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

540 TRINITY LN N APT 8220
ST PETERSBURG FL
33716-1332
US

V. Phone/Fax

Practice location:
  • Phone: 813-643-1389
  • Fax:
Mailing address:
  • Phone: 630-849-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: