Provider Demographics
NPI:1396126447
Name:JARRARD, PAULA DORLAND (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:DORLAND
Last Name:JARRARD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 W FRY RD
Mailing Address - Street 2:
Mailing Address - City:GOSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47433-9529
Mailing Address - Country:US
Mailing Address - Phone:317-903-7833
Mailing Address - Fax:812-237-3615
Practice Address - Street 1:1198 W FRY RD
Practice Address - Street 2:
Practice Address - City:GOSPORT
Practice Address - State:IN
Practice Address - Zip Code:47433-9529
Practice Address - Country:US
Practice Address - Phone:317-903-7833
Practice Address - Fax:812-237-3615
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003872A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist