Healthcare Provider Details

I. General information

NPI: 1215056429
Provider Name (Legal Business Name): PAULA JEAN MCCANN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CROOKED CREEK RD
GREENWOOD AR
72936-3026
US

IV. Provider business mailing address

1004 CROOKED CREEK RD
GREENWOOD AR
72936-3026
US

V. Phone/Fax

Practice location:
  • Phone: 479-996-7718
  • Fax:
Mailing address:
  • Phone: 479-996-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number199
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: