Provider Demographics
NPI:1235476441
Name:JARRELL, KATHY BOWMAN (OTR, CHT)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:BOWMAN
Last Name:JARRELL
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 CHOWNING CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4008
Mailing Address - Country:US
Mailing Address - Phone:804-545-4952
Mailing Address - Fax:804-545-4953
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-545-4952
Practice Address - Fax:804-545-4953
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist