Individual
MR. CHAD BOWCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
135 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 661-8823
(309) 661-8801
Mailing address
PO BOX 5387, BLOOMINGTON, IL 61702-5387
(309) 661-8823
(309) 661-8801
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056004599
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056004599
LICENSE
IL
Enumeration date
11/24/2008
Last updated
11/24/2008
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