Provider Demographics
NPI:1932941986
Name:COWELL, KEVIN LESLIE
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LESLIE
Last Name:COWELL
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 1:1105 PIMLICO PARK
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8020
Mailing Address - Country:US
Mailing Address - Phone:419-262-7645
Mailing Address - Fax:
Practice Address - Street 1:1105 PIMLICO PARK
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8020
Practice Address - Country:US
Practice Address - Phone:419-262-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC172319172A00000X
OH251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No172A00000XOther Service ProvidersDriver