Provider Demographics
NPI:1073125688
Name:POWELL THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:POWELL THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CANDIDATE MA CAS
Authorized Official - Phone:860-983-8112
Mailing Address - Street 1:3 JESSIE LN
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9596
Mailing Address - Country:US
Mailing Address - Phone:860-983-8112
Mailing Address - Fax:
Practice Address - Street 1:3 JESSIE LN
Practice Address - Street 2:
Practice Address - City:BROAD BROOK
Practice Address - State:CT
Practice Address - Zip Code:06016-9596
Practice Address - Country:US
Practice Address - Phone:860-983-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0080-96340Medicaid