Provider Demographics
NPI:1316785090
Name:POWELL, HAROLD ETHAN
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:ETHAN
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42465 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7052
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:256-355-0884
Practice Address - Street 1:125 MEDICAL PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5302
Practice Address - Country:US
Practice Address - Phone:334-428-7040
Practice Address - Fax:334-222-6983
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist