Provider Demographics
NPI:1194166538
Name:STOMMES, PAULA M (OTR L)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:STOMMES
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:STOMMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9401 WINNETKA AVE. N
Mailing Address - Street 2:RELIABLE MEDICAL SUPPLY
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445
Mailing Address - Country:US
Mailing Address - Phone:763-255-3810
Mailing Address - Fax:763-255-3910
Practice Address - Street 1:9401 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-1618
Practice Address - Country:US
Practice Address - Phone:763-255-3810
Practice Address - Fax:763-255-3910
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-07-15
Deactivation Date:2013-03-19
Deactivation Code:
Reactivation Date:2013-07-15
Provider Licenses
StateLicense IDTaxonomies
MN102195225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
081H2BROtherBCBS MINNESOTA
HP56110OtherHEALTHPARTNERS
6405939OtherMEDICA