Basic Information
| Provider Information | |||||||||
| NPI: | 1992866073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | ANNA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CAAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1129 NEVADA AVE | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387278 | ||||||||
| FaxNumber: | 5305387315 | ||||||||
| Practice Location | |||||||||
| Address1: | 564 RIO LINDO AVENUE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308793950 | ||||||||
| FaxNumber: | 5308793949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.