Basic Information
Provider Information
NPI: 1649421637
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: PAULA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MT-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1120 S. CALUMET, #3
Address2:  
City: CHESTERTON
State: IN
PostalCode: 463043286
CountryCode: US
TelephoneNumber: 2199839675
FaxNumber:  
Practice Location
Address1: 1120 S CALUMET RD STE 3
Address2:  
City: CHESTERTON
State: IN
PostalCode: 463043286
CountryCode: US
TelephoneNumber: 2199839675
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/08/2008
LastUpdateDate: 10/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225A00000X3398 Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist 

No ID Information.


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