Provider Demographics
NPI:1639721632
Name:FOWLKES-ARTHURS, PORSCHE ALEXANDRIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PORSCHE
Middle Name:ALEXANDRIA
Last Name:FOWLKES-ARTHURS
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 1:8282 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7680
Mailing Address - Country:US
Mailing Address - Phone:909-569-3742
Mailing Address - Fax:
Practice Address - Street 1:8282 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7680
Practice Address - Country:US
Practice Address - Phone:909-569-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist