Provider Demographics
NPI:1487391512
Name:PAULLIS, EMILY (OT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PAULLIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRANITE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5626
Mailing Address - Country:US
Mailing Address - Phone:617-691-7140
Mailing Address - Fax:617-507-0457
Practice Address - Street 1:500 GRANITE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5626
Practice Address - Country:US
Practice Address - Phone:617-691-7140
Practice Address - Fax:617-507-0457
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14314OtherMA BOARD OF ALLIED HEALTH PROFESSIONALS