Provider Demographics
NPI:1295279305
Name:POWELL, SYKEMA (MA, COTA,)
Entity type:Individual
Prefix:
First Name:SYKEMA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, COTA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BENSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1327
Mailing Address - Country:US
Mailing Address - Phone:845-300-9543
Mailing Address - Fax:
Practice Address - Street 1:88 BENSON ST APT 1
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1327
Practice Address - Country:US
Practice Address - Phone:845-300-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant