Healthcare Provider Details

I. General information

NPI: 1104540418
Provider Name (Legal Business Name): DONALD O OWUOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAIN ST STE 25
TEWKSBURY MA
01876-4700
US

IV. Provider business mailing address

1501 MAIN ST STE 25
TEWKSBURY MA
01876-4700
US

V. Phone/Fax

Practice location:
  • Phone: 978-455-3288
  • Fax: 978-455-3297
Mailing address:
  • Phone: 978-455-3288
  • Fax: 978-455-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: