Provider Demographics
NPI:1316367923
Name:PRESCOTT, PAULA A
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:A
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11346 STRATTON AVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4422
Mailing Address - Country:US
Mailing Address - Phone:612-919-1155
Mailing Address - Fax:
Practice Address - Street 1:300 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5395
Practice Address - Country:US
Practice Address - Phone:612-919-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310037174400000X
225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist