Provider Demographics
NPI:1780835074
Name:FOWLES, REBECCA ANN (OT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:FOWLES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 GRAND CONCOURSE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1404
Mailing Address - Country:US
Mailing Address - Phone:718-584-5130
Mailing Address - Fax:718-584-5130
Practice Address - Street 1:3131 GRAND CONCOURSE APT 3C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1404
Practice Address - Country:US
Practice Address - Phone:718-584-5130
Practice Address - Fax:718-584-5130
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007487-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist