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General NPI Number Information
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NPI Number | 1467577676
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Entity Type | Individual
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Provider Name | LAURA OWENS MT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 49 DARTMOUTH ST SUITE 102
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City | PORTLAND
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State | ME
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Zip | 04101-1700
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Country | US
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Telephone | 207-773-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 49 DARTMOUTH ST SUITE 102
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City | PORTLAND
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State | ME
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Zip | 04101-1700
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Country | US
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Telephone | 207-773-7788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MT1356
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License Number State | ME
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