MEDICARE: MRS. LORI WALKER BOWMAN COTA/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	224Z00000X	Occupational Therapy Assistant	0131000063	VA

General Provider Information

NPI Number	:	1629209895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI WALKER BOWMAN COTA/L

Provider Business Mailing Address
First Line	:	1659 HEADLEY RD
Second Line	:
City	:	MAURERTOWN
State	:	VA
Zip	:	22644-2692
Country	:	US
Telephone Number	:	540-436-8532
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARK WEST CIR
Second Line	:	SUITE 108
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5551
Country	:	US
Telephone Number	:	800-969-9265
Fax Number	:

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

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	08/05/2009

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