Provider Demographics
NPI:1609085398
Name:BOWEN, KENDRA LEIGH (OTRL)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N CARRIE ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3714
Mailing Address - Country:US
Mailing Address - Phone:620-504-2772
Mailing Address - Fax:
Practice Address - Street 1:1202 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5656
Practice Address - Country:US
Practice Address - Phone:620-669-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17 02799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist