Provider Demographics
NPI:1861641532
Name:BOWEN, CANDACE (OTA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OTA
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 583
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-0583
Mailing Address - Country:US
Mailing Address - Phone:870-687-1306
Mailing Address - Fax:
Practice Address - Street 1:1320 MAUL NORTH WEST ROAD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701
Practice Address - Country:US
Practice Address - Phone:870-836-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0854224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant