Provider Demographics
NPI:1275845885
Name:WESLEY, PAULA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:MELBYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:3014 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3658
Mailing Address - Country:US
Mailing Address - Phone:920-459-3028
Mailing Address - Fax:
Practice Address - Street 1:3014 ERIE AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3658
Practice Address - Country:US
Practice Address - Phone:920-459-3028
Practice Address - Fax:920-459-4341
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI493-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20865381OtherSUNNYRIDGE HEALTH AND REHABILITATION CENTER