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General NPI Number Information
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NPI Number | 1578979464
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Entity Type | Individual
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Provider Name | NOELLE SUZANNE OWEN ATC
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Gender | Female
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 5967 FINZEL RD
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City | WHITEHOUSE
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State | OH
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Zip | 43571-9661
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Country | US
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Telephone | 419-877-0927
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Fax | 419-877-1206
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Provider Business Mailing Address
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Address Line | 6950 FREDERICKSBURG DR S
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City | SYLVANIA
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State | OH
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Zip | 43560-3229
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Country | US
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Telephone | 419-410-3222
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT. 003526
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License Number State | OH
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