MEDICARE: MICHAEL ROBERT MCGOWAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR00293600	NJ

General Provider Information

NPI Number	:	1063508596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBERT MCGOWAN

Provider Business Mailing Address
First Line	:	14 WINSTED DR
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-2347
Country	:	US
Telephone Number	:	732-232-8747
Fax Number	:	732-370-3621

Provider Business Practice Location Address
First Line	:	509 ROUTE 530
Second Line	:	KESWICK PINES LIFECARE
City	:	WHITING
State	:	NJ
Zip	:	08759-3145
Country	:	US
Telephone Number	:	732-849-0849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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