Provider Demographics
NPI:1164798054
Name:POWELL, BETTY J (CFTS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PARKWOOD BLVD W
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3566
Mailing Address - Country:US
Mailing Address - Phone:252-265-9827
Mailing Address - Fax:252-265-9851
Practice Address - Street 1:1800 PARKWOOD BLVD W
Practice Address - Street 2:SUITE A
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3566
Practice Address - Country:US
Practice Address - Phone:252-265-9827
Practice Address - Fax:252-265-9851
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000828974225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter