Provider Demographics
NPI:1013249085
Name:BOWMAN, SAMANTHA SHAWN
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:SHAWN
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:SHAWN
Other - Last Name:O'HEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 S WOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6825
Mailing Address - Country:US
Mailing Address - Phone:918-756-9250
Mailing Address - Fax:918-756-9187
Practice Address - Street 1:1803 S WOOD DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6825
Practice Address - Country:US
Practice Address - Phone:918-756-9250
Practice Address - Fax:918-756-9187
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker