Provider Demographics
NPI:1811364219
Name:PAULSEN, WILMA JEAN
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:JEAN
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILLIE
Other - Middle Name:
Other - Last Name:PAULSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:314 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1720
Mailing Address - Country:US
Mailing Address - Phone:517-676-0686
Mailing Address - Fax:517-676-0686
Practice Address - Street 1:2193 ASSOCIATION DR
Practice Address - Street 2:STE700
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4903
Practice Address - Country:US
Practice Address - Phone:517-449-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist