Organization
POWELL THERAPY SOLUTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA POWELL PHD CANDIDATE MA CAS (PROVIDER)
(860) 983-8112
Entity
Organization
Contact information
Practice address
3 JESSIE LN, BROAD BROOK, CT 06016-9596
(860) 983-8112
Mailing address
3 JESSIE LN, BROAD BROOK, CT 06016-9596
(860) 983-8112
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080-96340
—
CT
Enumeration date
08/17/2020
Last updated
07/27/2022
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