Individual
ANGELA MARY PAULY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
83 AIRWAYS PL, SOUTHAVEN, MS 38671-5885
(662) 349-8787
Mailing address
1312 GASTON DR, SOUTHAVEN, MS 38671-7046
(903) 293-3338
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
107497
TX
174400000X
Specialist
Primary
OT2488
MS
174400000X
Specialist
OTR1109
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145182721
—
AR
Enumeration date
03/21/2007
Last updated
08/13/2010
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