Provider Demographics
NPI:1063301257
Name:OWEN, NAKIHLAN THERAL-LAROY
Entity type:Individual
Prefix:
First Name:NAKIHLAN
Middle Name:THERAL-LAROY
Last Name:OWEN
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 1:4315 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3838
Mailing Address - Country:US
Mailing Address - Phone:912-980-3330
Mailing Address - Fax:
Practice Address - Street 1:4315 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3838
Practice Address - Country:US
Practice Address - Phone:912-980-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator