Provider Demographics
NPI:1811546294
Name:BOWMAN, REBECCA LYNN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 LANE CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3153
Mailing Address - Country:US
Mailing Address - Phone:530-262-8823
Mailing Address - Fax:
Practice Address - Street 1:29516 KOHOUTEK WAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1221
Practice Address - Country:US
Practice Address - Phone:510-441-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist