Provider Demographics
NPI:1326771064
Name:ANDERSON, PAMELA JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:ANDERSON
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 1:560 N MCNEELY ST
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9279
Mailing Address - Country:US
Mailing Address - Phone:701-429-8044
Mailing Address - Fax:
Practice Address - Street 1:21106 SR 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8788
Practice Address - Country:US
Practice Address - Phone:425-264-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60437067225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT60437067OtherWASHINGTON STATE DEPARTMENT OF HEALTH