Individual
WILLIE J POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2844 TRACELAND DR, TUPELO, MS 38801-4200
(662) 680-3148
Mailing address
2844 TRACELAND DR., TUPELO, MS 38803
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2611
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314000000X
BLUE CROSS BLUE SHIELD
MS
Enumeration date
04/23/2012
Last updated
04/23/2012
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