MEDICARE: KASEY DANIELLE POWLISON

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

General Provider Information

NPI Number	:	1023891009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY DANIELLE POWLISON

Provider Business Mailing Address
First Line	:	632 KORB RD
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9685
Country	:	US
Telephone Number	:	570-404-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 KORB RD
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9685
Country	:	US
Telephone Number	:	570-404-2451
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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Directions to “ KASEY DANIELLE POWLISON ” Practice Location

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