Individual
JERI LYN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
414 ROBEY STREET, FRANKLIN, KY 42134
(270) 586-7141
Mailing address
312 LONGVIEW DR., RUSSELLVILLE, KY 42276
(270) 779-0581
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A4175
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A4175
COTA STATE LICENSE
KY
Enumeration date
03/30/2010
Last updated
03/30/2010
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