Provider Demographics
NPI:1942758685
Name:PHILLIPS, PAULA (OT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 FAIRLANDING AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-6818
Mailing Address - Country:US
Mailing Address - Phone:469-450-7488
Mailing Address - Fax:
Practice Address - Street 1:8600 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4198
Practice Address - Country:US
Practice Address - Phone:214-355-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist