Provider Demographics
NPI:1528565041
Name:BOWERS, STEPHEN MICHAEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:BOWERS
Suffix:
Gender:M
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 1:124 HARTLEY LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17889-9129
Mailing Address - Country:US
Mailing Address - Phone:570-713-4766
Mailing Address - Fax:
Practice Address - Street 1:2 MANOR BLVD
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-8757
Practice Address - Country:US
Practice Address - Phone:717-436-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006163224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant