Provider Demographics
NPI:1508003492
Name:BOWDEN, CHERYL LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17024 SE 104TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-8104
Mailing Address - Country:US
Mailing Address - Phone:405-760-1751
Mailing Address - Fax:405-310-6894
Practice Address - Street 1:17024 SE 104TH ST
Practice Address - Street 2:
Practice Address - City:NEWALLA
Practice Address - State:OK
Practice Address - Zip Code:74857-8104
Practice Address - Country:US
Practice Address - Phone:405-760-1751
Practice Address - Fax:405-310-6894
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPTA1321171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor