Provider Demographics
NPI:1821103110
Name:BOWDREN, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BOWDREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 NW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5915
Mailing Address - Country:US
Mailing Address - Phone:954-757-5858
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3179
Practice Address - Country:US
Practice Address - Phone:954-474-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4509OtherLICENSE #