Provider Demographics
NPI:1083914816
Name:REYNAUD, PAMELA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:REYNAUD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E HUNTER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9202
Mailing Address - Country:US
Mailing Address - Phone:856-332-1569
Mailing Address - Fax:
Practice Address - Street 1:11 E HUNTER CREEK LN
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9202
Practice Address - Country:US
Practice Address - Phone:856-332-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00207400225X00000X
PAOC011810225XP0200X
DE2013605263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist