Provider Demographics
NPI:1558567024
Name:NOWAK, COLETTE RENEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:RENEE
Last Name:NOWAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 E. OAKRIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4014
Mailing Address - Country:US
Mailing Address - Phone:419-215-1007
Mailing Address - Fax:419-727-1791
Practice Address - Street 1:5232 N. SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611
Practice Address - Country:US
Practice Address - Phone:419-215-1007
Practice Address - Fax:419-727-1791
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33 013537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist