Provider Demographics
NPI:1639371420
Name:THOMAS, PAULETTE R (CHW)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 LONE OAK RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4743
Mailing Address - Country:US
Mailing Address - Phone:503-871-0062
Mailing Address - Fax:
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2522
Practice Address - Country:US
Practice Address - Phone:503-485-3655
Practice Address - Fax:503-375-8700
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12288225700000X
ORTHW000106796172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist