Healthcare Provider Details

I. General information

NPI: 1598181620
Provider Name (Legal Business Name): JAMES BOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LUPI CT SUITE 150
PALM COAST FL
32137-4761
US

IV. Provider business mailing address

31 LUPI CT SUITE 150
PALM COAST FL
32137-4761
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-0011
  • Fax: 386-447-0161
Mailing address:
  • Phone: 386-447-0011
  • Fax: 386-447-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA7966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: