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General NPI Number Information
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NPI Number | 1063930626
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Entity Type | Organization
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Legal Business Name | STOW RECOVERY SPECIALISTS, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 4502 DARROW RD
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City | STOW
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State | OH
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Zip | 44224
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Country | US
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Telephone | 330-915-2990
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Fax | 888-746-3547
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Provider Business Mailing Address
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Address Line | 4502 DARROW RD
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City | STOW
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State | OH
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Zip | 44224
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Country | US
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Telephone | 330-915-2990
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Fax | 888-746-3547
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON TODD KOLB
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Credential | M.D.
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Telephone | 330-414-4599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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