Provider Demographics
NPI:1710399571
Name:POWERS, MONICA (LPT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GERARD DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2497
Mailing Address - Country:US
Mailing Address - Phone:419-681-2441
Mailing Address - Fax:
Practice Address - Street 1:16 GERARD DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2497
Practice Address - Country:US
Practice Address - Phone:419-681-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT7314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist