Provider Demographics
NPI:1083773816
Name:OWEN, CAROL LOUISE (CMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:OWEN
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-0092
Mailing Address - Country:US
Mailing Address - Phone:530-934-7046
Mailing Address - Fax:530-934-5830
Practice Address - Street 1:201 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0206
Practice Address - Country:US
Practice Address - Phone:408-376-0900
Practice Address - Fax:408-376-0886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist