Provider Demographics
NPI:1972000545
Name:BAYLOR, PAMELA FORREST (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:FORREST
Last Name:BAYLOR
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4131
Mailing Address - Country:US
Mailing Address - Phone:773-696-9050
Mailing Address - Fax:773-847-5920
Practice Address - Street 1:3059 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4131
Practice Address - Country:US
Practice Address - Phone:773-696-9050
Practice Address - Fax:773-847-5920
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist