Provider Demographics
NPI:1063508596
Name:MCGOWAN, MICHAEL ROBERT
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINSTED DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2347
Mailing Address - Country:US
Mailing Address - Phone:732-232-8747
Mailing Address - Fax:732-370-3621
Practice Address - Street 1:509 ROUTE 530
Practice Address - Street 2:KESWICK PINES LIFECARE
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3145
Practice Address - Country:US
Practice Address - Phone:732-849-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00293600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist