Healthcare Provider Details

I. General information

NPI: 1881377919
Provider Name (Legal Business Name): SCOTT M. BOWEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 1ST AVE N STE 200
SEATTLE WA
98109-4765
US

IV. Provider business mailing address

415 1ST AVE N STE 200
SEATTLE WA
98109-4765
US

V. Phone/Fax

Practice location:
  • Phone: 206-859-5030
  • Fax:
Mailing address:
  • Phone: 206-859-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC61165228
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: