Provider Demographics
NPI:1588891246
Name:BOWMAN, JAN J (MED, CTRS)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:J
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MED, CTRS
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:JEAN
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CTRS
Mailing Address - Street 1:1218 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1824
Mailing Address - Country:US
Mailing Address - Phone:501-296-9109
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26697OtherNATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION