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NPI Code Detail

MEDICARE: MANDI FOWLKES

MEDICARE: MANDI FOWLKES
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
1225X00000XOccupational Therapist108268TX

General Provider Information

NPI Number : 1083098826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDI FOWLKES
Provider Business Mailing Address
First Line : 502 RIVER POINTE DR
Second Line :
City : CONROE
State : TX
Zip : 77304-2838
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 502 RIVER POINTE DR
Second Line :
City : CONROE
State : TX
Zip : 77304-2838
Country : US
Telephone Number : 936-207-1265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2015
Last Update Date : 07/10/2015

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Directions to “ MANDI FOWLKES ” Practice Location

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