Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119000025 | VA |
NPI | 1003835851 |
---|---|
Provider Name | Mrs. Kimberly Jo Powell |
First Address | Glen Allen, VA 23059-5704 |
Second Address | Richmond, VA 23249-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |