Provider Demographics
NPI:1417291162
Name:MERRILL, PAMELA JO (COTA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JO
Last Name:MERRILL
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 1:4379 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-9581
Mailing Address - Country:US
Mailing Address - Phone:360-279-2413
Mailing Address - Fax:
Practice Address - Street 1:330 E CRESCENT HARBOR RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-9142
Practice Address - Country:US
Practice Address - Phone:360-279-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant