=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649081886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAROLD RAY SOWARDS II B.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 5TH AVE W
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25704-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-528-3430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3192 BIG CREEK ROAD
-----------------------------------------------------
City | HAMLIN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-730-0288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------