Provider Demographics
NPI:1922230754
Name:BIALIK, PAMELA SUE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:BIALIK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-1539
Mailing Address - Country:US
Mailing Address - Phone:906-428-3493
Mailing Address - Fax:
Practice Address - Street 1:1024 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-1539
Practice Address - Country:US
Practice Address - Phone:906-428-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201001365OtherSTATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BOARD OF OCCUPATIONAL THERAPIST