Provider Demographics
NPI:1669884292
Name:POWELL, CARLA ANN (COTA/L, PAMPCA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:COTA/L, PAMPCA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ANN
Other - Last Name:SIMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MONT ALTO
Mailing Address - State:PA
Mailing Address - Zip Code:17237-9601
Mailing Address - Country:US
Mailing Address - Phone:717-217-9938
Mailing Address - Fax:
Practice Address - Street 1:9 WILLOW ST
Practice Address - Street 2:
Practice Address - City:MONT ALTO
Practice Address - State:PA
Practice Address - Zip Code:17237-9601
Practice Address - Country:US
Practice Address - Phone:717-217-9938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01897224Z00000X
PAOP007308224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant