Provider Demographics
NPI:1922008515
Name:BOWLUS, DIANE APRIL (OT/L)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:APRIL
Last Name:BOWLUS
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:CENTRAL
Other - Middle Name:ARIZONA
Other - Last Name:THERAPY LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-0640
Mailing Address - Country:US
Mailing Address - Phone:928-567-7330
Mailing Address - Fax:928-567-4146
Practice Address - Street 1:513 AZURE DR
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7276
Practice Address - Country:US
Practice Address - Phone:928-567-7330
Practice Address - Fax:928-567-4146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1785225X00000X, 225XH1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ556003OtherAHCCCS
AZZ63467Medicare ID - Type UnspecifiedMEDICARE ID