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NPI Code Detail

MEDICARE: MRS. CLAUDETTE MYNES PAULEY MOT, OTR/L

MEDICARE: MRS. CLAUDETTE MYNES PAULEY MOT, OTR/L
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
1225X00000XOccupational Therapist1236WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811095953
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CLAUDETTE MYNES PAULEY MOT, OTR/L
Provider Business Mailing Address
First Line : 9122 CLEAR FORK RD
Second Line : P.O. BOX 173
City : DOROTHY
State : WV
Zip : 25060-9655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 ELIZABETH ST
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-2119
Country : US
Telephone Number : 304-766-0361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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