Provider Demographics
NPI:1679898035
Name:POWELL, MARTHA R (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:R
Last Name:POWELL
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 1:3917 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:NC
Mailing Address - Zip Code:27350-8865
Mailing Address - Country:US
Mailing Address - Phone:336-491-6034
Mailing Address - Fax:336-498-2146
Practice Address - Street 1:3917 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:NC
Practice Address - Zip Code:27350-8865
Practice Address - Country:US
Practice Address - Phone:336-491-6034
Practice Address - Fax:336-498-2146
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC400225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation