Provider Demographics
NPI:1114269412
Name:WALASIK, PAMELA SUE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:WALASIK
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 1:13678 SAMHILL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-3948
Mailing Address - Country:US
Mailing Address - Phone:301-829-6228
Mailing Address - Fax:
Practice Address - Street 1:350 MONTEVUE LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8214
Practice Address - Country:US
Practice Address - Phone:301-600-1659
Practice Address - Fax:301-600-3280
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist