Provider Demographics
NPI:1104540418
Name:OWUOR, DONALD O
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:O
Last Name:OWUOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MAIN ST STE 25
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4700
Mailing Address - Country:US
Mailing Address - Phone:978-455-3288
Mailing Address - Fax:978-455-3297
Practice Address - Street 1:1501 MAIN ST STE 25
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4700
Practice Address - Country:US
Practice Address - Phone:978-455-3288
Practice Address - Fax:978-455-3297
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency