Provider Demographics
NPI:1023216009
Name:BOWE, ASHLEY NICHOLE (MOT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:BOWE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:BOTTORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT
Mailing Address - Street 1:5203 DELLWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-415-6180
Mailing Address - Fax:
Practice Address - Street 1:314 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE 13 MEDCARE THERAPY CENTER
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-5031
Practice Address - Fax:304-204-6332
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810008946Medicaid