MEDICARE: SUZIE ANN POWERS

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	222Q00000X	Developmental Therapist		FL

General Provider Information

NPI Number	:	1790648681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZIE ANN POWERS

Provider Business Mailing Address
First Line	:	5589 WHEELER PL
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-8540
Country	:	US
Telephone Number	:	850-605-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	5589 WHEELER PL
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-8540
Country	:	US
Telephone Number	:	850-605-6476
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ SUZIE ANN POWERS ” Practice Location

Language	Start Address	Practice Location

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