Provider Demographics
NPI:1306055736
Name:BOWDISH, TRACY JO (MM NMT FELLOW, MT-BC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JO
Last Name:BOWDISH
Suffix:
Gender:F
Credentials:MM NMT FELLOW, MT-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:JO
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MM NMT FELLOW, MT-BC
Mailing Address - Street 1:600 GRESHEM DRIVE
Mailing Address - Street 2:SENTARA HEART HOSPITAL SUITE 8630
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-388-6163
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHEM DRIVE
Practice Address - Street 2:SENTARA HEART HOSPITAL SUITE 8630
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-388-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist