Provider Demographics
NPI:1841581279
Name:THAYER, PAULA L (OTRL)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:L
Last Name:THAYER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 ARROWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905-8565
Mailing Address - Country:US
Mailing Address - Phone:508-255-1640
Mailing Address - Fax:
Practice Address - Street 1:264 ARROWOOD RD
Practice Address - Street 2:
Practice Address - City:MARBLE
Practice Address - State:NC
Practice Address - Zip Code:28905-8565
Practice Address - Country:US
Practice Address - Phone:508-255-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2963225700000X
NC7761225X00000X
MA8720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist