Provider Demographics
NPI:1346309739
Name:BOWDEN, FAWN ANGELIC (O T)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:ANGELIC
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:O T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-9782
Mailing Address - Country:US
Mailing Address - Phone:319-653-5494
Mailing Address - Fax:319-863-9016
Practice Address - Street 1:511 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9782
Practice Address - Country:US
Practice Address - Phone:319-653-5494
Practice Address - Fax:319-863-9016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01552224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant