Provider Demographics
NPI:1568684686
Name:MOWLE, MONIQUE LINDSLEY (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:LINDSLEY
Last Name:MOWLE
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RED MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-9326
Mailing Address - Country:US
Mailing Address - Phone:845-246-9343
Mailing Address - Fax:
Practice Address - Street 1:250 TUYTENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5429
Practice Address - Country:US
Practice Address - Phone:845-336-7235
Practice Address - Fax:845-336-4726
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005775-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473001Medicaid
NYW03821Medicare ID - Type Unspecified
NY00473001Medicaid