Provider Demographics
NPI:1275767568
Name:BOWEN, KATHRYN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14999 THOROUGHBRED RUN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-8990
Mailing Address - Country:US
Mailing Address - Phone:616-638-2002
Mailing Address - Fax:
Practice Address - Street 1:14999 THOROUGHBRED RUN
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8990
Practice Address - Country:US
Practice Address - Phone:616-638-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer