Provider Demographics
NPI:1326579798
Name:YANKOWSKY, PAMELA JEAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:YANKOWSKY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E PITTSTON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5930
Mailing Address - Country:US
Mailing Address - Phone:207-649-2891
Mailing Address - Fax:
Practice Address - Street 1:821 E PITTSTON RD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:ME
Practice Address - Zip Code:04345-5930
Practice Address - Country:US
Practice Address - Phone:207-649-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant