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Individual

TARA SUZANNE POWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
501 N 3RD ST, PADUCAH, KY 42001-0749
(270) 444-9661
Mailing address
PO BOX 821, VIENNA, IL 62995-0821
(618) 771-6838

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A5079
KY

Other

Enumeration date
01/23/2013
Last updated
01/23/2013
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