Healthcare Provider Details

I. General information

NPI: 1447112974
Provider Name (Legal Business Name): TIMIAH LASHAYE OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 E COUNTY LINE RD
MINERAL RIDGE OH
44440-9411
US

IV. Provider business mailing address

9722 ROSEWOOD AVE
CLEVELAND OH
44105-6725
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-3800
  • Fax: 614-844-3800
Mailing address:
  • Phone: 216-816-7811
  • Fax: 216-816-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberUT960305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: