Healthcare Provider Details

I. General information

NPI: 1306055736
Provider Name (Legal Business Name): TRACY JO BOWDISH MM NMT FELLOW, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY JO KIEL MM NMT FELLOW, MT-BC

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHEM DRIVE SENTARA HEART HOSPITAL SUITE 8630
NORFOLK VA
23507
US

IV. Provider business mailing address

600 GRESHEM DRIVE SENTARA HEART HOSPITAL SUITE 8630
NORFOLK VA
23507
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6163
  • Fax:
Mailing address:
  • Phone: 757-388-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: