Provider Demographics
NPI:1174941926
Name:FOWLER, SUSAN MARIE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 BOWDLE RD
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45850-9729
Mailing Address - Country:US
Mailing Address - Phone:567-204-0914
Mailing Address - Fax:
Practice Address - Street 1:4153 BOWDLE RD
Practice Address - Street 2:
Practice Address - City:HARROD
Practice Address - State:OH
Practice Address - Zip Code:45850-9729
Practice Address - Country:US
Practice Address - Phone:567-204-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant