Provider Demographics
NPI:1922253939
Name:SMITH, PAMELA JEAN I (OTR)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:SMITH
Suffix:I
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:102 SCHOHARIE PLANK RD. W
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009
Mailing Address - Country:US
Mailing Address - Phone:518-641-8188
Mailing Address - Fax:
Practice Address - Street 1:102 SCHOHARIE PLANK RD. W
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009
Practice Address - Country:US
Practice Address - Phone:518-641-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005454-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist