Provider Demographics
NPI:1922452879
Name:SEELEY, PAULA A (RBT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:SEELEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:A
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1780 MARY CT
Mailing Address - Street 2:#7
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1041
Mailing Address - Country:US
Mailing Address - Phone:989-763-4778
Mailing Address - Fax:
Practice Address - Street 1:1780 MARY CT
Practice Address - Street 2:#7
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1041
Practice Address - Country:US
Practice Address - Phone:989-763-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16-18038247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI247200000XMedicaid