Provider Demographics
NPI:1578979464
Name:OWEN, NOELLE SUZANNE (ATC)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:SUZANNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 FREDERICKSBURG DR S
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3229
Mailing Address - Country:US
Mailing Address - Phone:419-410-3222
Mailing Address - Fax:
Practice Address - Street 1:5967 FINZEL RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9661
Practice Address - Country:US
Practice Address - Phone:419-877-0927
Practice Address - Fax:419-877-1206
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0035262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer