Provider Demographics
NPI:1790491405
Name:NIEDZWIECKI, PAMELA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:NIEDZWIECKI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 KEMPTON LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0226
Mailing Address - Country:US
Mailing Address - Phone:424-245-9660
Mailing Address - Fax:
Practice Address - Street 1:5 KEMPTON LN
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0226
Practice Address - Country:US
Practice Address - Phone:424-245-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22945225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing