Provider Demographics
NPI:1275341075
Name:POWERS, ANGELA ELLIS (OTR/L, CHT, CLT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELLIS
Last Name:POWERS
Suffix:
Gender:F
Credentials:OTR/L, CHT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 FLAT ROCK ACRES
Mailing Address - Street 2:
Mailing Address - City:CRUMPLER
Mailing Address - State:NC
Mailing Address - Zip Code:28617-9495
Mailing Address - Country:US
Mailing Address - Phone:301-752-3117
Mailing Address - Fax:
Practice Address - Street 1:1918 W PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3563
Practice Address - Country:US
Practice Address - Phone:301-752-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5245225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation