Provider Demographics
NPI:1407177090
Name:ANDERSON, PAMELA (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9733 NICKLEBY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7803
Mailing Address - Country:US
Mailing Address - Phone:704-543-4227
Mailing Address - Fax:704-543-4227
Practice Address - Street 1:9733 NICKLEBY CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7803
Practice Address - Country:US
Practice Address - Phone:704-543-4227
Practice Address - Fax:704-543-4227
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist