Provider Demographics
NPI:1215179197
Name:PAUL, KIRUBADAS A (OTR)
Entity Type:Individual
Prefix:MR
First Name:KIRUBADAS
Middle Name:A
Last Name:PAUL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 FOXBAY LN
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6360
Mailing Address - Country:US
Mailing Address - Phone:717-480-8375
Mailing Address - Fax:
Practice Address - Street 1:131 FOXBAY LN
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6360
Practice Address - Country:US
Practice Address - Phone:717-480-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006186L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist