Provider Demographics
NPI:1265048110
Name:OWREY, CAROLYN ELAINE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:OWREY
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:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0284
Mailing Address - Country:US
Mailing Address - Phone:740-978-0338
Mailing Address - Fax:
Practice Address - Street 1:114 E CROSS ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656-1246
Practice Address - Country:US
Practice Address - Phone:740-978-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0311471Medicaid