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General NPI Number Information
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NPI Number | 1114473873
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Entity Type | Individual
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Provider Name | CHERRY LACRETA BOWEN ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 709 E OKLAHOMA BLVD
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City | ALVA
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State | OK
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Zip | 73717-7371
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Country | US
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Telephone | 361-227-7355
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Fax |
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Provider Business Mailing Address
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Address Line | 709 OKLAHOMA BLVD
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City | ALVA
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State | OK
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Zip | 73717-2749
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Country | US
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Telephone | 361-227-7355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 743
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License Number State | OK
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