MEDICARE: TINA BOWERS OTR/L

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	R1331	KY

General Provider Information

NPI Number	:	1508245739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA BOWERS OTR/L

Provider Business Mailing Address
First Line	:	600 GLEN CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-1306
Country	:	US
Telephone Number	:	502-494-5302
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 GLEN CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-1306
Country	:	US
Telephone Number	:	502-494-5302
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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