Provider Demographics
NPI:1760638738
Name:PASOL, JERRY (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:PASOL
Suffix:
Gender:M
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:PO BOX 113394
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-3394
Mailing Address - Country:US
Mailing Address - Phone:907-334-9002
Mailing Address - Fax:
Practice Address - Street 1:6613 BRAYTON DR STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2153
Practice Address - Country:US
Practice Address - Phone:907-334-9002
Practice Address - Fax:907-334-9320
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT45641Medicaid