Provider Demographics
NPI:1376796425
Name:SMITH, PAMELA BETH (MA,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NOB HL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5545
Mailing Address - Country:US
Mailing Address - Phone:845-462-8485
Mailing Address - Fax:
Practice Address - Street 1:9 NOB HL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5545
Practice Address - Country:US
Practice Address - Phone:845-462-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003620-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist