Provider Demographics
NPI:1215382403
Name:BOWDEN, GINA MARIE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:PICKERILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:32471 ROAD N
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:NE
Mailing Address - Zip Code:68944-2138
Mailing Address - Country:US
Mailing Address - Phone:402-460-6554
Mailing Address - Fax:
Practice Address - Street 1:32471 ROAD N
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:NE
Practice Address - Zip Code:68944-2138
Practice Address - Country:US
Practice Address - Phone:402-460-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification