Provider Demographics
NPI:1184477341
Name:VAN ALEN, PAULA KAY
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:VAN ALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4904
Mailing Address - Country:US
Mailing Address - Phone:209-841-8240
Mailing Address - Fax:
Practice Address - Street 1:1231 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4904
Practice Address - Country:US
Practice Address - Phone:209-841-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1292224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant