Healthcare Provider Details

I. General information

NPI: 1720796592
Provider Name (Legal Business Name): PAMELA KAY VENCIL MAIER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA KAY VENCIL OTR/L

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

IV. Provider business mailing address

2943 ZARTHAN AVE S
ST LOUIS PARK MN
55416-1811
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax:
Mailing address:
  • Phone: 515-556-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: