Provider Demographics
NPI:1932300837
Name:SIERRA, PAMELA WRIGHT (OTRL)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:WRIGHT
Last Name:SIERRA
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 1:8 DEERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3254
Mailing Address - Country:US
Mailing Address - Phone:978-682-5692
Mailing Address - Fax:
Practice Address - Street 1:500 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4937
Practice Address - Country:US
Practice Address - Phone:978-458-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist