Basic Information
Provider Information
NPI: 1821149592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COPELAND
FirstName: PAULA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: OTL
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 85 KANEY RIDGE RD
Address2:  
City: GREENBRIER
State: AR
PostalCode: 720589684
CountryCode: US
TelephoneNumber: 5016798691
FaxNumber:  
Practice Location
Address1: 2915 DAVE WARD DR
Address2: SUITE 8
City: CONWAY
State: AR
PostalCode: 720349310
CountryCode: US
TelephoneNumber: 5013295459
FaxNumber: 5013251378
Other Information
ProviderEnumerationDate: 01/16/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200XOTR2026ARY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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