Provider Demographics
NPI:1194283390
Name:COLLINS, PAULA RENAE (OTR, ATP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:RENAE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 GATEWAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8900
Mailing Address - Country:US
Mailing Address - Phone:812-450-8580
Mailing Address - Fax:812-842-3693
Practice Address - Street 1:2034 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4596
Practice Address - Country:US
Practice Address - Phone:812-450-8580
Practice Address - Fax:812-842-3693
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000583A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist