Individual
BLAKE RAYMOND BOWERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1988 NEWMARK AVE, COOS BAY, OR 97420-2911
(541) 888-7430
(541) 888-7196
Mailing address
2770 32ND ST, COOS BAY, OR 97420-3541
(541) 888-7430
(541) 888-7196
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-367795
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT-AT-367795
OREGON HEALTH LICENSING O
OR
Enumeration date
03/14/2007
Last updated
07/08/2007
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