Basic Information
| Provider Information | |||||||||
| NPI: | 1932491396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | LEESA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13831 BOTTS RD | ||||||||
| Address2: | |||||||||
| City: | GRANDVIEW | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64030 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 JEFFERSON PKWY | ||||||||
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| City: | HARRISONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163804731 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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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 | 2007010438 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 17-02417 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.