Provider Demographics
NPI:1447401542
Name:GOWER, HOLLIE LOUISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:LOUISE
Last Name:GOWER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 514
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-9658
Mailing Address - Country:US
Mailing Address - Phone:570-234-6564
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 514
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058-9658
Practice Address - Country:US
Practice Address - Phone:570-234-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006123224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant