=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609656461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA MERCIER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2023
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 E 4TH ST
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72801-5132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-397-1851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 214
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72837-0214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-389-2695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 3796
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------