Individual
MRS. TRACEY L FOWL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTERS IN SPED
Contact information
Practice address
1651 OPTIMIST RD, ELIZABETHTOWN, KY 42701-6152
(270) 763-8011
(270) 763-8011
Mailing address
1651 OPTIMIST RD, ELIZABETHTOWN, KY 42701-6152
(270) 763-8011
(270) 763-8011
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
EPSB ID: 71846
KY
Other
Enumeration date
06/21/2008
Last updated
03/08/2013
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