Provider Demographics
NPI:1770873374
Name:BOWERMAN, KELSEY ANN (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:BOWERMAN
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 1:300 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:VELVA
Mailing Address - State:ND
Mailing Address - Zip Code:58790-7342
Mailing Address - Country:US
Mailing Address - Phone:701-338-2072
Mailing Address - Fax:701-338-2031
Practice Address - Street 1:300 MAIN ST S
Practice Address - Street 2:
Practice Address - City:VELVA
Practice Address - State:ND
Practice Address - Zip Code:58790-7342
Practice Address - Country:US
Practice Address - Phone:701-338-2072
Practice Address - Fax:701-338-2031
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist