Provider Demographics
NPI:1164787206
Name:SLEDGE, PAMELA ANGILETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANGILETTE
Last Name:SLEDGE
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 1:6190 OLD FRANCONIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2593
Mailing Address - Country:US
Mailing Address - Phone:571-245-6985
Mailing Address - Fax:888-501-0356
Practice Address - Street 1:6190 OLD FRANCONIA RD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2593
Practice Address - Country:US
Practice Address - Phone:571-245-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist