Provider Demographics
NPI:1336334044
Name:VOGT, PAMELA KAY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:VOGT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36119 86TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-8094
Mailing Address - Country:US
Mailing Address - Phone:360-832-1075
Mailing Address - Fax:360-832-1075
Practice Address - Street 1:36119 86TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-8094
Practice Address - Country:US
Practice Address - Phone:360-832-1075
Practice Address - Fax:360-832-1075
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist