Provider Demographics
NPI:1346679974
Name:GOWAN, JOSHUA AARON (COTAL)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:AARON
Last Name:GOWAN
Suffix:
Gender:M
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 BERKELEY PL NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-4018
Mailing Address - Country:US
Mailing Address - Phone:618-973-5872
Mailing Address - Fax:
Practice Address - Street 1:2701 CLARE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3313
Practice Address - Country:US
Practice Address - Phone:360-377-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60262132224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant