Provider Demographics
NPI:1700122132
Name:MCCOY-POWLEN, JENNA DEANNE (OTR, RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:DEANNE
Last Name:MCCOY-POWLEN
Suffix:
Gender:F
Credentials:OTR, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8899
Mailing Address - Country:US
Mailing Address - Phone:317-344-2341
Mailing Address - Fax:317-663-1154
Practice Address - Street 1:2702 DEER RUN
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8899
Practice Address - Country:US
Practice Address - Phone:317-777-0073
Practice Address - Fax:317-663-1154
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005144A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics