Provider Demographics
NPI:1922163849
Name:WEDEKING, PAMELA MARIE (OTRL)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:MARIE
Last Name:WEDEKING
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2050
Mailing Address - Country:US
Mailing Address - Phone:847-691-5670
Mailing Address - Fax:
Practice Address - Street 1:221 US HIGHWAY 41 STE H
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1278
Practice Address - Country:US
Practice Address - Phone:219-322-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005144225X00000X
IN31006366A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist