MEDICARE: PAULA FRAZIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		IN

General Provider Information

NPI Number	:	1962536169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA FRAZIER

Provider Business Mailing Address
First Line	:	6881 W 100 S
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9753
Country	:	US
Telephone Number	:	765-748-9786
Fax Number	:

Provider Business Practice Location Address
First Line	:	6239 S EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2090
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	10/05/2018

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Directions to “ PAULA FRAZIER ” Practice Location

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