Provider Demographics
NPI:1235566704
Name:BOWLES, ELIZABETH A (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5257
Mailing Address - Country:US
Mailing Address - Phone:315-422-1689
Mailing Address - Fax:931-542-2206
Practice Address - Street 1:851 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:315-422-1689
Practice Address - Fax:931-542-2206
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003798225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5261OtherSTATE LICENSE