Provider Demographics
NPI:1245383819
Name:OWENS, CARLA D
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:D
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6284 APPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3507
Mailing Address - Country:US
Mailing Address - Phone:330-965-9650
Mailing Address - Fax:
Practice Address - Street 1:6284 APPLERIDGE DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3507
Practice Address - Country:US
Practice Address - Phone:330-965-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH105659073899Medicare ID - Type Unspecified