Provider Demographics
NPI:1821616301
Name:BOWKER, DANEEL NICOLE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DANEEL
Middle Name:NICOLE
Last Name:BOWKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:DANEEL
Other - Middle Name:NICOLE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11280 E DE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9455
Mailing Address - Country:US
Mailing Address - Phone:517-376-0853
Mailing Address - Fax:
Practice Address - Street 1:11280 E DE AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9455
Practice Address - Country:US
Practice Address - Phone:517-376-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist