Healthcare Provider Details

I. General information

NPI: 1023523487
Provider Name (Legal Business Name): OCTAVEYA LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38882 MENTOR AVE
WILLOUGHBY OH
44094-7875
US

IV. Provider business mailing address

8908 PARMELEE AVE
CLEVELAND OH
44108-2838
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9999
  • Fax: 440-918-3839
Mailing address:
  • Phone: 216-255-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: