Provider Demographics
NPI:1508345141
Name:MCLANE-BOWES, MARIE (MPS, ATR, LCAT, CCLS)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:MCLANE-BOWES
Suffix:
Gender:F
Credentials:MPS, ATR, LCAT, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1341
Mailing Address - Country:US
Mailing Address - Phone:197-836-1696
Mailing Address - Fax:
Practice Address - Street 1:41 GILBERT ST
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-1341
Practice Address - Country:US
Practice Address - Phone:845-581-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001540-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist