Provider Demographics
NPI:1093302515
Name:ABBOTT, PAMELA (COTA/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOOSILAUKEE DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-2509
Mailing Address - Country:US
Mailing Address - Phone:678-739-9251
Mailing Address - Fax:
Practice Address - Street 1:386 BELAIRE DR
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3313
Practice Address - Country:US
Practice Address - Phone:706-896-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001504224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant