Provider Demographics
NPI:1740656214
Name:POWLEY, BREANNE (OTRL)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:POWLEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:SONNTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 JOHN KNOX DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235
Mailing Address - Country:US
Mailing Address - Phone:989-450-7874
Mailing Address - Fax:
Practice Address - Street 1:1575 JOHN KNOX DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9662
Practice Address - Country:US
Practice Address - Phone:989-450-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist