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General NPI Number Information
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NPI Number | 1326771064
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Entity Type | Individual
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Provider Name | PAMELA JO ANDERSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 21106 SR 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8788
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Country | US
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Telephone | 425-264-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 560 N MCNEELY ST
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City | BUCKLEY
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State | WA
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Zip | 98321-9279
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Country | US
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Telephone | 701-429-8044
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 60437067
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License Number State | WA
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