Healthcare Provider Details

I. General information

NPI: 1558520627
Provider Name (Legal Business Name): PAMELA ANN SPOHR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 COLLEGE AVE
GOSHEN IN
46528-5010
US

IV. Provider business mailing address

1260 EASTGATE DR
KENDALLVILLE IN
46755-9306
US

V. Phone/Fax

Practice location:
  • Phone: 574-528-0406
  • Fax:
Mailing address:
  • Phone: 260-318-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number99032525A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: