MEDICARE: PAMELA VASILOFF OTR/L

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	225X00000X	Occupational Therapist	2137	OH

General Provider Information

NPI Number	:	1437558921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA VASILOFF OTR/L

Provider Business Mailing Address
First Line	:	4746 LARKIN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-5961
Country	:	US
Telephone Number	:	614-325-3966
Fax Number	:

Provider Business Practice Location Address
First Line	:	12640 SABRE SPRINGS PKWY
Second Line	:	SUITE 111
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4113
Country	:	US
Telephone Number	:	619-647-6157
Fax Number	:

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

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	08/20/2014

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