MEDICARE: SAMANTHA BOWKER

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	2255A2300X	Athletic Trainer	003907	OH

General Provider Information

NPI Number	:	1124465232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BOWKER

Provider Business Mailing Address
First Line	:	1501 TWIN OAKS DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-4036
Country	:	US
Telephone Number	:	219-241-3377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 TWIN OAKS DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-4036
Country	:	US
Telephone Number	:	219-241-3377
Fax Number	:

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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