Provider Demographics
NPI:1871882944
Name:BOWERS, KATIE LYNN (ATC, LAT, CSCS)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYNN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1199
Mailing Address - Country:US
Mailing Address - Phone:262-370-3484
Mailing Address - Fax:
Practice Address - Street 1:900 WOOD RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1199
Practice Address - Country:US
Practice Address - Phone:262-370-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0034602255A2300X
OHAT.0033982255A2300X
WI2113-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer