Provider Demographics
NPI:1346611142
Name:BOWEN, THERESA (MOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S. VILLAGE DRIVE N
Mailing Address - Street 2:#103
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:727-385-2841
Mailing Address - Fax:
Practice Address - Street 1:810 S. VILLAGE DRIVE N
Practice Address - Street 2:#103
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-385-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist