Healthcare Provider Details

I. General information

NPI: 1184556706
Provider Name (Legal Business Name): PAUL ALLEN MCCULLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WASHINGTON ST APT C
COVENTRY RI
02816-5443
US

IV. Provider business mailing address

450 WASHINGTON ST APT C
COVENTRY RI
02816-5443
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-4134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number20580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: