Provider Demographics
NPI:1538306378
Name:AVOLEN, LLC
Entity Type:Organization
Organization Name:AVOLEN, LLC
Other - Org Name:AVOLEN WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:262-567-3000
Mailing Address - Street 1:206 S. SILVER LAKE ST.
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-3000
Mailing Address - Fax:262-567-5082
Practice Address - Street 1:206 S. SILVER LAKE ST.
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-567-3000
Practice Address - Fax:262-567-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
WI4330-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty