Provider Demographics
NPI:1740575570
Name:REA-TURNER, PAULINE MARIE (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:MARIE
Last Name:REA-TURNER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N RITTER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5710
Mailing Address - Country:US
Mailing Address - Phone:317-417-4905
Mailing Address - Fax:
Practice Address - Street 1:317 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5710
Practice Address - Country:US
Practice Address - Phone:317-417-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000962A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN#3100962AOtherOCCUPATIONAL THERAPY LICENSE