Provider Demographics
NPI:1497975122
Name:BOWMAN, SHANNON PAIGE (OT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAIGE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4518
Mailing Address - Country:US
Mailing Address - Phone:701-523-7848
Mailing Address - Fax:701-523-4878
Practice Address - Street 1:14 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4518
Practice Address - Country:US
Practice Address - Phone:701-523-7848
Practice Address - Fax:701-523-4878
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist