Provider Demographics
NPI:1215056429
Name:MCCANN, PAULA JEAN (OTR)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CROOKED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-3026
Mailing Address - Country:US
Mailing Address - Phone:479-996-7718
Mailing Address - Fax:
Practice Address - Street 1:1004 CROOKED CREEK RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3026
Practice Address - Country:US
Practice Address - Phone:479-996-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR199171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor