Provider Demographics
NPI:1528848298
Name:BOWER, DESTINY MICHELLE (BS)
Entity type:Individual
Prefix:MS
First Name:DESTINY
Middle Name:MICHELLE
Last Name:BOWER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 N LA FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1527
Mailing Address - Country:US
Mailing Address - Phone:208-440-9546
Mailing Address - Fax:
Practice Address - Street 1:3682 N LA FONTANA WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1527
Practice Address - Country:US
Practice Address - Phone:208-440-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist