Provider Demographics
NPI:1760229447
Name:OWEN, LORI JUNE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JUNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 TERRACE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3710
Mailing Address - Country:US
Mailing Address - Phone:330-303-5877
Mailing Address - Fax:
Practice Address - Street 1:730 TERRACE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3710
Practice Address - Country:US
Practice Address - Phone:330-303-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN524017347E00000X
376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No347E00000XTransportation ServicesTransportation Broker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant