Provider Demographics
NPI:1619047149
Name:BINGHAM, PAULA (OTR)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:422 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0343
Mailing Address - Country:US
Mailing Address - Phone:706-864-2851
Mailing Address - Fax:706-864-2851
Practice Address - Street 1:422 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0343
Practice Address - Country:US
Practice Address - Phone:706-864-2851
Practice Address - Fax:706-864-2851
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00804603BMedicaid