Provider Demographics
NPI:1518595594
Name:FOWLER, ALLISON LEIGH
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-4832
Mailing Address - Country:US
Mailing Address - Phone:850-572-7624
Mailing Address - Fax:
Practice Address - Street 1:260 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-4832
Practice Address - Country:US
Practice Address - Phone:850-572-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant