Provider Demographics
NPI:1437335775
Name:BOYLES, PAMELA ELAINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELAINE
Last Name:BOYLES
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 1:3435 MARTIN WAY E
Mailing Address - Street 2:SUITE C
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5071
Mailing Address - Country:US
Mailing Address - Phone:360-459-4836
Mailing Address - Fax:
Practice Address - Street 1:3435 MARTIN WAY E
Practice Address - Street 2:SUITE C
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5071
Practice Address - Country:US
Practice Address - Phone:360-923-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist