Provider Demographics
NPI:1609112341
Name:BOWDEN, KELLY N (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:N
Other - Last Name:LEPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1089 CULPEPPER RD
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8122
Mailing Address - Country:US
Mailing Address - Phone:443-326-9733
Mailing Address - Fax:
Practice Address - Street 1:1089 CULPEPPER RD
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8122
Practice Address - Country:US
Practice Address - Phone:443-326-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17803225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology