Provider Demographics
NPI:1336758333
Name:BOWEN, KRISTIN SHA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SHA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11610 APEX VIEW DR APT 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-8308
Mailing Address - Country:US
Mailing Address - Phone:606-233-3417
Mailing Address - Fax:
Practice Address - Street 1:11610 APEX VIEW DR APT 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-8308
Practice Address - Country:US
Practice Address - Phone:606-233-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist