Provider Demographics
NPI:1427673078
Name:BOWDEN, NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S HOPE ST APT 925
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4691
Mailing Address - Country:US
Mailing Address - Phone:850-556-4216
Mailing Address - Fax:
Practice Address - Street 1:8167 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4314
Practice Address - Country:US
Practice Address - Phone:323-655-2023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
FL17203224Z00000X
CA4895224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant