MEDICARE: PAMELA ANTOINETTE STEWART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	628	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	628	OTHER	CA	CERTIFIED OCCUPATIONAL THERAPY ASSISTANT

General Provider Information

NPI Number	:	1215309208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANTOINETTE STEWART

Provider Business Mailing Address
First Line	:	77 N HOLLISTON AVE
Second Line	:	APT 4
City	:	PASADENA
State	:	CA
Zip	:	91106-1944
Country	:	US
Telephone Number	:	626-616-2962
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 N HOLLISTON AVE
Second Line	:	APT 4
City	:	PASADENA
State	:	CA
Zip	:	91106-1944
Country	:	US
Telephone Number	:	626-616-2962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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Directions to “ PAMELA ANTOINETTE STEWART ” Practice Location

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