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General NPI Number Information
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NPI Number | 1346727450
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Entity Type | Individual
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Provider Name | MICHELLE P PAVELEK MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 2478 13TH ST SE
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City | SALEM
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State | OR
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Zip | 97302
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Country | US
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Telephone | 503-779-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 COLORADO DR NW
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City | SALEM
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State | OR
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Zip | 97304-1666
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Country | US
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Telephone | 503-508-5518
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4809
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 4809
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License Number State | OR
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