Provider Demographics
NPI:1265434732
Name:BOWLER, LAURIE B (ATC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:B
Last Name:BOWLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20521 124TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5462
Mailing Address - Country:US
Mailing Address - Phone:253-686-9993
Mailing Address - Fax:
Practice Address - Street 1:5403 MILWAUKEE AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-2774
Practice Address - Country:US
Practice Address - Phone:253-686-9993
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer