Provider Demographics
NPI:1093112179
Name:CLICK, PAULA (COTA/L # 2638)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CLICK
Suffix:
Gender:F
Credentials:COTA/L # 2638
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 STONEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9437
Mailing Address - Country:US
Mailing Address - Phone:740-962-3259
Mailing Address - Fax:
Practice Address - Street 1:2378 STONEY POINT RD
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9437
Practice Address - Country:US
Practice Address - Phone:740-962-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02638174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist