Provider Demographics
NPI:1629312178
Name:PURK, PAMELA A (COTA/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:PURK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E US ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-8202
Mailing Address - Country:US
Mailing Address - Phone:937-418-4806
Mailing Address - Fax:
Practice Address - Street 1:490 E US ROUTE 36
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-8202
Practice Address - Country:US
Practice Address - Phone:937-418-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant