MEDICARE: HAROLD ETHAN POWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	4891	AL

General Provider Information

NPI Number	:	1316785090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD ETHAN POWELL

Provider Business Mailing Address
First Line	:	42465 HIGHWAY 195
Second Line	:
City	:	HALEYVILLE
State	:	AL
Zip	:	35565-7052
Country	:	US
Telephone Number	:	256-350-1764
Fax Number	:	256-355-0884

Provider Business Practice Location Address
First Line	:	125 MEDICAL PARK DR STE 106
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5302
Country	:	US
Telephone Number	:	334-428-7040
Fax Number	:	334-222-6983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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Directions to “ HAROLD ETHAN POWELL ” Practice Location

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