Provider Demographics
NPI:1114473873
Name:BOWEN, CHERRY LACRETA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:LACRETA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 OKLAHOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2749
Mailing Address - Country:US
Mailing Address - Phone:361-227-7355
Mailing Address - Fax:
Practice Address - Street 1:709 E OKLAHOMA BLVD
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-7371
Practice Address - Country:US
Practice Address - Phone:361-227-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer