Provider Demographics
NPI:1871366302
Name:BOWMAN, KAITLIN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BOWMAN
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 1:4296 STATE ROUTE 598
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-9734
Mailing Address - Country:US
Mailing Address - Phone:419-631-3462
Mailing Address - Fax:
Practice Address - Street 1:4296 STATE ROUTE 598
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-9734
Practice Address - Country:US
Practice Address - Phone:419-631-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012702225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist