Provider Demographics
NPI:1932733458
Name:POWELL, ALLISYNN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISYNN
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 E DEL LATON DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2344
Mailing Address - Country:US
Mailing Address - Phone:224-234-5696
Mailing Address - Fax:
Practice Address - Street 1:9050 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-4356
Practice Address - Country:US
Practice Address - Phone:480-586-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist