Provider Demographics
NPI:1326801531
Name:FOWLER, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FOWLER
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 1:57 TOWNSHIP ROAD 1275
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-8030
Mailing Address - Country:US
Mailing Address - Phone:740-451-0907
Mailing Address - Fax:740-451-0311
Practice Address - Street 1:57 TOWNSHIP ROAD 1275
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-8030
Practice Address - Country:US
Practice Address - Phone:740-451-0307
Practice Address - Fax:740-451-0311
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator