Provider Demographics
NPI:1891756722
Name:WITTHAUS, PAMELA A (OTR/L, CHT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:WITTHAUS
Suffix:
Gender:F
Credentials:OTR/L, CHT
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 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:6970 FOX HUNT LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5394
Practice Address - Country:US
Practice Address - Phone:804-694-8111
Practice Address - Fax:804-694-5574
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192945OtherBCBS (OCCUPATIONAL THERAPY)
VA11446180OtherCAQH
VA7596331OtherAETNA
VAP00651588OtherRAILROAD MEDICARE
VA1891756722Medicaid
VAMC11459Medicare PIN
VA11446180OtherCAQH