Provider Demographics
NPI:1457583213
Name:BOWEN, VIRGINIA 'GIGI' LEIGH (COTA/LL)
Entity Type:Individual
Prefix:
First Name:VIRGINIA 'GIGI'
Middle Name:LEIGH
Last Name:BOWEN
Suffix:
Gender:F
Credentials:COTA/LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6883
Mailing Address - Country:US
Mailing Address - Phone:864-973-9623
Mailing Address - Fax:864-973-9624
Practice Address - Street 1:539 BENTON ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6883
Practice Address - Country:US
Practice Address - Phone:864-973-9623
Practice Address - Fax:864-973-9624
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2450OtherSC STATE OCCUPATIONAL THERAPY LICENCE