Individual
PAUL MARVIN THEILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 376-1611
Mailing address
122 SE 70TH CIR, OCALA, FL 34472-7962
(352) 615-0936
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
80710
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80710
NCTRC CTRS
MS
Enumeration date
04/08/2021
Last updated
04/08/2021
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