Provider Demographics
NPI:1154761526
Name:BOWEN, MICHAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2062
Mailing Address - Country:US
Mailing Address - Phone:401-330-8172
Mailing Address - Fax:
Practice Address - Street 1:315 OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2062
Practice Address - Country:US
Practice Address - Phone:541-386-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME225X00000X
OR225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist