Provider Demographics
NPI:1295905966
Name:POWELL, ROBERTA ADAMS (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ADAMS
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CHESHIRE BRIDGE RD NE
Mailing Address - Street 2:APT 8208
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2124 CHESHIRE BRIDGE RD NE
Practice Address - Street 2:APT 8208
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5708
Practice Address - Country:US
Practice Address - Phone:205-266-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist