Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | Z12232 | LA |
NPI | 1346541570 |
---|---|
Provider Name | Summer Powell |
First Address | West Monroe, LA 71294-1377 |
Second Address | West Monroe, LA 71291-3501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2010 |
Last Update Date | 01/04/2021 |