Provider Demographics
NPI:1174268569
Name:BOWMAN, ROSALIE SUSAN CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:SUSAN CAROL
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 ORONOKE RD APT 7-7
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3938
Mailing Address - Country:US
Mailing Address - Phone:207-341-4331
Mailing Address - Fax:
Practice Address - Street 1:827 ORONOKE RD APT 7-7
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3938
Practice Address - Country:US
Practice Address - Phone:207-341-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist