Provider Demographics
NPI:1629240866
Name:GRIEP, PAMELA CATHERINE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:CATHERINE
Last Name:GRIEP
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:CATHERINE
Other - Last Name:CARLSTROM-GRIEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:8301 RICH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-4706
Mailing Address - Country:US
Mailing Address - Phone:239-464-4135
Mailing Address - Fax:
Practice Address - Street 1:8301 RICH RD
Practice Address - Street 2:
Practice Address - City:NORTH FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-4706
Practice Address - Country:US
Practice Address - Phone:239-464-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant