MEDICARE: MS. NIELA POWELL ADC

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	225800000X	Recreation Therapist	APC400239	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568394427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIELA POWELL ADC

Provider Business Mailing Address
First Line	:	4796 ALTER RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48215-2146
Country	:	US
Telephone Number	:	586-214-3306
Fax Number	:

Provider Business Practice Location Address
First Line	:	4796 ALTER RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48215-2146
Country	:	US
Telephone Number	:	586-214-3306
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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