Provider Demographics
NPI:1922410638
Name:SAMUELSON, PAULA (MOT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:BETH
Other - Last Name:KRAYENHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4725 MERLE HAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD STE 107
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist