Healthcare Provider Details

I. General information

NPI: 1912121286
Provider Name (Legal Business Name): MRS. GLENDA DARLENE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 THOMPSON HILL RD
OTWAY OH
45657-9086
US

IV. Provider business mailing address

857 THOMPSON HILL RD
OTWAY OH
45657-9086
US

V. Phone/Fax

Practice location:
  • Phone: 740-372-0115
  • Fax: 740-965-8576
Mailing address:
  • Phone: 740-372-0115
  • Fax: 740-965-8576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: