Provider Demographics
NPI:1679290498
Name:POWERS, GABRIELLE NICHOLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:NICHOLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8707
Mailing Address - Country:US
Mailing Address - Phone:865-406-4202
Mailing Address - Fax:
Practice Address - Street 1:105 FELLOWSHIP LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-7654
Practice Address - Country:US
Practice Address - Phone:865-213-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7486225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty