MEDICARE: DEVENCE POWELL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1760015945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVENCE POWELL

Provider Business Mailing Address
First Line	:	700 ABBOTT DR UNIT 2
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-4323
Country	:	US
Telephone Number	:	484-444-2285
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 ABBOTT DR UNIT 2
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-4323
Country	:	US
Telephone Number	:	484-444-2285
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “ DEVENCE POWELL ” Practice Location

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