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General NPI Number Information
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NPI Number | 1164850640
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Entity Type | Organization
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Legal Business Name | JENNIFER BOWEN OT
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 18 PERLEY AVE
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City | LEBANON
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State | NH
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Zip | 03766-1817
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Country | US
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Telephone | 858-761-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 18 PERLEY AVE
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City | LEBANON
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State | NH
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Zip | 03766-1817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OTR/L
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Name | JENNIFER BOWEN
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Credential |
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Telephone | 858-761-3429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 072.0085243
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License Number State | VT
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