Provider Demographics
NPI:1033676531
Name:OWENS, MARLON L
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:L
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 EATON RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4336
Mailing Address - Country:US
Mailing Address - Phone:216-702-4415
Mailing Address - Fax:216-472-8521
Practice Address - Street 1:2423 EATON RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4336
Practice Address - Country:US
Practice Address - Phone:216-702-4415
Practice Address - Fax:216-472-8521
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0271829343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)