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General NPI Number Information
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NPI Number | 1730017245
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Entity Type | Individual
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Provider Name | JOHNATHAN SCOTT POWELL
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Gender | Male
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 1438 COUNTY ROAD C E
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City | MAPLEWOOD
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State | MN
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Zip | 55109-9972
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Country | US
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Telephone | 651-272-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 3393 NORTHDALE BLVD NW APT 309
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City | COON RAPIDS
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State | MN
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Zip | 55448-1613
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Country | US
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Telephone | 859-893-1909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 106473
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License Number State | MN
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