Provider Demographics
NPI:1609111970
Name:SOWERS, BRENT ALLEN (OTR)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:SOWERS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5407
Mailing Address - Country:US
Mailing Address - Phone:219-742-5759
Mailing Address - Fax:
Practice Address - Street 1:2400 SILHAVY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3275
Practice Address - Country:US
Practice Address - Phone:219-462-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002360A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist