Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 21422 | CA |
Y | 225XE0001X | Environmental Modification | 21422 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 21422 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1871998823 |
---|---|
Provider Name | Mrs. Alyssa L. Bowser |
First Address | Santa Cruz, CA 95060-2022 |
Second Address | Seattle, WA 98199-4018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2014 |
Last Update Date | 07/12/2020 |