Provider Demographics
NPI:1598805194
Name:POWELL, CAROL FRYE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:FRYE
Last Name:POWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:FRYE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0587
Mailing Address - Country:US
Mailing Address - Phone:336-236-6546
Mailing Address - Fax:336-236-9546
Practice Address - Street 1:440 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2634
Practice Address - Country:US
Practice Address - Phone:336-236-6546
Practice Address - Fax:336-236-9546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0149225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7368681Medicaid