Healthcare Provider Details

I. General information

NPI: 1598859167
Provider Name (Legal Business Name): LAURI J. BOWLES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N. DAVIS
OKLAHOMA CITY OK
73127
US

IV. Provider business mailing address

1908 N. DAVIS
OKLAHOMA CITY OK
73127
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-9171
  • Fax:
Mailing address:
  • Phone: 405-789-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT156
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: