Healthcare Provider Details

I. General information

NPI: 1144599457
Provider Name (Legal Business Name): PAMELA SUE BERRY O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W MAIN ST
NEWARK OH
43055-5007
US

IV. Provider business mailing address

11177 LAMBS LN
NEWARK OH
43055-9779
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-2837
  • Fax: 740-348-4793
Mailing address:
  • Phone: 740-763-0408
  • Fax: 740-763-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: