Provider Demographics
NPI:1588678296
Name:POWELL, CYNTHIA G (OT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:G
Last Name:POWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851324
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1324
Mailing Address - Country:US
Mailing Address - Phone:251-476-0525
Mailing Address - Fax:251-476-5724
Practice Address - Street 1:351 S GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1904
Practice Address - Country:US
Practice Address - Phone:251-928-7312
Practice Address - Fax:251-928-8316
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0005225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51073563OtherBLUE CROSS
ALR79945Medicare UPIN