Provider Demographics
NPI:1548241136
Name:BOWLING, TERRI (OT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:BOWLING
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 1:9411 OLD HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-4410
Mailing Address - Country:US
Mailing Address - Phone:386-937-9840
Mailing Address - Fax:904-692-2444
Practice Address - Street 1:ONE ST. JOHNS MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4410
Practice Address - Country:US
Practice Address - Phone:904-797-1958
Practice Address - Fax:904-417-2055
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist