Healthcare Provider Details

I. General information

NPI: 1316060304
Provider Name (Legal Business Name): PAMELA MARIE WITHINGTON O.T.R.L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 6656
KEAAU HI
96749-9326
US

IV. Provider business mailing address

HC 2 BOX 6656
KEAAU HI
96749-9326
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-4414
  • Fax:
Mailing address:
  • Phone: 808-333-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number648
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: