Provider Demographics
NPI:1649421637
Name:WRIGHT, PAULA (MT-BC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S. CALUMET, #3
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3286
Mailing Address - Country:US
Mailing Address - Phone:219-983-9675
Mailing Address - Fax:
Practice Address - Street 1:1120 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3286
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3398225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist