Healthcare Provider Details

I. General information

NPI: 1497097224
Provider Name (Legal Business Name): MRS. PAULA W. HOOGERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 LILLINGTON AVE
CHARLOTTE NC
28204-3130
US

IV. Provider business mailing address

316 LILLINGTON AVE
CHARLOTTE NC
28204-3130
US

V. Phone/Fax

Practice location:
  • Phone: 980-819-8458
  • Fax:
Mailing address:
  • Phone: 980-819-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: