Active NPI
Paula Theele
- Occupational Therapist
- Port Orange, FL
National Provider Identifier
1104170828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2251
- Practice address
- 5535 S Williamson Blvd
Ste 774
Port Orange, FL 32128-8311 - Phone
- (800) 330-7711
- Fax
- (866) 426-2811
- NPI assigned
- Nov 2, 2012
- Last updated
- Nov 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2251 | CO | Primary |
Addresses
Primary practice location
5535 S Williamson Blvd
Ste 774
Port Orange, FL 32128-8311
Mailing address
532 N Impala Dr
Fort Collins, CO 80521-1519
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2251 | CO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1104170828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "532 N IMPALA DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805211519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5535 S WILLIAMSON BLVD",
"address_2": "STE 774",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321288311",
"telephone_number": "800-330-7711",
"fax_number": "866-426-2811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEELE",
"first_name": "PAULA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-02",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CO",
"license": "2251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.