Individual
PAULA SPRAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
(386) 447-4114
Mailing address
1096 KEYSTONE TRAIL DR, CHESTERFIELD, MO 63005-4265
(314) 494-5890
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
02180
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02180
LICENSE
MO
Enumeration date
11/16/2015
Last updated
11/16/2015
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