Provider Demographics
NPI:1225307218
Name:POWERS, YVONNE SANDRA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:SANDRA
Last Name:POWERS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HORICON AVE
Mailing Address - Street 2:
Mailing Address - City:BOLTON LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12814-7744
Mailing Address - Country:US
Mailing Address - Phone:518-644-2400
Mailing Address - Fax:
Practice Address - Street 1:69 SUN VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3900
Practice Address - Country:US
Practice Address - Phone:518-644-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013179-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist