Provider Demographics
NPI:1053643312
Name:VANDEVANDER, PAMELA J (OT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:VANDEVANDER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-1000
Mailing Address - Country:US
Mailing Address - Phone:540-932-5159
Mailing Address - Fax:540-932-4616
Practice Address - Street 1:501 OAK AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4400
Practice Address - Country:US
Practice Address - Phone:540-941-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist