Provider Demographics
NPI:1962953992
Name:POWELL, CIARA (COTA)
Entity type:Individual
Prefix:MS
First Name:CIARA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14343 E 12 MILE RD
Mailing Address - Street 2:APT. A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3852
Mailing Address - Country:US
Mailing Address - Phone:313-895-6332
Mailing Address - Fax:
Practice Address - Street 1:25700 LAHSER RD
Practice Address - Street 2:IRVINE NEURO REHABILITATION CENTER
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2625
Practice Address - Country:US
Practice Address - Phone:248-415-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006923224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant