Provider Demographics
NPI:1679230304
Name:BOWERS, ROBERT (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:MS, 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:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0778
Mailing Address - Country:US
Mailing Address - Phone:907-314-0808
Mailing Address - Fax:907-766-2104
Practice Address - Street 1:69 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0778
Practice Address - Country:US
Practice Address - Phone:907-766-2101
Practice Address - Fax:907-766-2104
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004861L225X00000X
AK185083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPENDINGMedicaid