Provider Demographics
NPI:1609166222
Name:WILSON, PAULA JEAN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLEVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02839-1156
Mailing Address - Country:US
Mailing Address - Phone:401-568-9306
Mailing Address - Fax:
Practice Address - Street 1:26 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:MAPLEVILLE
Practice Address - State:RI
Practice Address - Zip Code:02839-1156
Practice Address - Country:US
Practice Address - Phone:401-568-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant