Healthcare Provider Details

I. General information

NPI: 1285441261
Provider Name (Legal Business Name): VINCENT TYLER BOWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 BROADWAY ST
ANDERSON IN
46012-1258
US

IV. Provider business mailing address

6351 JAMESFIELD CT
FAIRFIELD OH
45014-4533
US

V. Phone/Fax

Practice location:
  • Phone: 765-400-4021
  • Fax:
Mailing address:
  • Phone: 513-291-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2836247
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: