Provider Demographics
NPI:1639370455
Name:POWELL, PATRICIA ANN (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:COTAL
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Mailing Address - Street 1:701 WEST WETMORE ROAD
Mailing Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE ROAD
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1685224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant