Healthcare Provider Details

I. General information

NPI: 1487781258
Provider Name (Legal Business Name): PAMELA SUE LAWSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GOOSE HILL RD
COLD SPRING HARBOR NY
11724-1318
US

IV. Provider business mailing address

1 GABRIEL CT
GREENLAWN NY
11740-2143
US

V. Phone/Fax

Practice location:
  • Phone: 631-367-5940
  • Fax:
Mailing address:
  • Phone: 631-262-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: