Provider Demographics
NPI:1619024783
Name:BERMAN, PAMALA
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMALA
Other - Middle Name:
Other - Last Name:SEHLMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6580 GRANT COURT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5844
Mailing Address - Country:US
Mailing Address - Phone:954-966-2975
Mailing Address - Fax:
Practice Address - Street 1:6580 GRANT CT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5844
Practice Address - Country:US
Practice Address - Phone:954-966-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43415225700000X
FLOT9257225X00000X
225X00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885444100Medicaid
FL885444196Medicaid