Provider Demographics
NPI:1851893697
Name:POWERS, JORDAN NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:NICOLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 CHART HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8367
Mailing Address - Country:US
Mailing Address - Phone:910-728-1371
Mailing Address - Fax:
Practice Address - Street 1:4141 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1978
Practice Address - Country:US
Practice Address - Phone:863-774-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18999225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist