Provider Demographics
NPI:1811598550
Name:ROWELL, ANTHONY M (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:ROWELL
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W VANCE ST
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2243
Mailing Address - Country:US
Mailing Address - Phone:980-234-2953
Mailing Address - Fax:
Practice Address - Street 1:620 HEATHWOOD DR
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8604
Practice Address - Country:US
Practice Address - Phone:610-444-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13606224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant