Provider Demographics
NPI:1558420034
Name:PAGUIO, PAMELA CORPUS (OTR)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:CORPUS
Last Name:PAGUIO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 LATITUDE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8152
Mailing Address - Country:US
Mailing Address - Phone:803-631-5483
Mailing Address - Fax:
Practice Address - Street 1:252 LATITUDE LN STE 103
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8152
Practice Address - Country:US
Practice Address - Phone:803-818-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11464225X00000X
TX110280225X00000X
SC5137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157093901Medicaid
TX86356TOtherBLUE CROSS BLUE SHIELD
SCTH3210Medicaid