Provider Demographics
NPI:1205936283
Name:BJORALT, PAULA (OTR)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BJORALT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2302 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 N 25TH ST E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5269
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:763-689-5558
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1553225X00000X
MN102999225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403351OtherMEDICA
WI41810700Medicaid
MN111M2BJOtherBLUE CROSS BLUE SHIELD
WI477564478000OtherCOMPCARE BLUE
MNHP45702OtherHEALTH PARTNERS
MN246533Medicare ID - Type UnspecifiedHEALTH DIMENSIONS REHAB