Provider Demographics
NPI:1417260050
Name:MISCIOSCIA, PAMELA SUE (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:MISCIOSCIA
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 150TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2024
Mailing Address - Country:US
Mailing Address - Phone:718-263-4004
Mailing Address - Fax:718-793-9812
Practice Address - Street 1:7035 150TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2024
Practice Address - Country:US
Practice Address - Phone:718-263-4004
Practice Address - Fax:718-793-9812
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014841-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics