Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT17803 | FL |
NPI | 1609112341 |
---|---|
Provider Name | Kelly N Bowden |
First Address | Green Cove Springs, FL 32043-8122 |
Second Address | Green Cove Springs, FL 32043-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2012 |
Last Update Date | 23/04/2019 |