Provider Demographics
NPI:1417508128
Name:BOWEN, BRIDGETTE A (MED, LPAT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:A
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MED, LPAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 STEVENS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1065
Mailing Address - Country:US
Mailing Address - Phone:815-975-4150
Mailing Address - Fax:
Practice Address - Street 1:3121 BROOKLAWN CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1282
Practice Address - Country:US
Practice Address - Phone:502-451-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243760221700000X
KY274117221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist