Provider Demographics
NPI:1104006907
Name:MAXWELL, PAULA KAY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:KAY
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N LOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-9476
Mailing Address - Country:US
Mailing Address - Phone:815-244-7715
Mailing Address - Fax:
Practice Address - Street 1:1006 N LOWDEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-9476
Practice Address - Country:US
Practice Address - Phone:815-244-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007582225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist