Healthcare Provider Details

I. General information

NPI: 1932941986
Provider Name (Legal Business Name): MR. KEVIN LESLIE COWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 PIMLICO PARK
HOLLAND OH
43528-8020
US

IV. Provider business mailing address

1105 PIMLICO PARK
HOLLAND OH
43528-8020
US

V. Phone/Fax

Practice location:
  • Phone: 419-262-7645
  • Fax:
Mailing address:
  • Phone: 419-262-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSC172319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: