Basic Information
| Provider Information | |||||||||
| NPI: | 1033444526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWERS | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 386 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467838810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604022274 | ||||||||
| FaxNumber: | 2604022274 | ||||||||
| Practice Location | |||||||||
| Address1: | 4180 SAGE BLUFF CROSSING | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604437300 | ||||||||
| FaxNumber: | 2604825005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2009 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31003893A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.