Provider Demographics
NPI:1285827535
Name:POWELL, RETHA YVETTE
Entity type:Individual
Prefix:
First Name:RETHA
Middle Name:YVETTE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RETHA
Other - Middle Name:YVETTE
Other - Last Name:ANCRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL
Mailing Address - Street 2:300B
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2268
Mailing Address - Country:US
Mailing Address - Phone:301-599-9500
Mailing Address - Fax:
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:200
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:301-599-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist