Provider Demographics
NPI:1679031421
Name:KOCHANEK, PAULA ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANN
Last Name:KOCHANEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 OLD MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5504
Mailing Address - Country:US
Mailing Address - Phone:401-744-5025
Mailing Address - Fax:
Practice Address - Street 1:17 ASHTON PKWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4827
Practice Address - Country:US
Practice Address - Phone:401-744-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI00646OtherMASSAGE
RI00646OtherLICENSE
RI00646OtherMASSAGE THERAPY