Provider Demographics
NPI:1154353803
Name:BOWER, LYNN SHADEL (OT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:SHADEL
Last Name:BOWER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SHADEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:3399 TRINDLE RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4407
Practice Address - Country:US
Practice Address - Phone:717-230-3459
Practice Address - Fax:717-230-3411
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005264L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC005264LOtherLICENSE