Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31003405A | IN |
NPI | 1093036238 |
---|---|
Provider Name | Mrs. Emma Jane Powell |
First Address | Broomfield, CO 80021-8077 |
Second Address | Lafayette, CO 80026-3482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 12/11/2016 |