Provider Demographics
NPI:1356530216
Name:MOTTLA, PAMELA PENNEY (OT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:PENNEY
Last Name:MOTTLA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:DODGE
Other - Last Name:PENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:ROOM S3-840
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:508-334-7177
Mailing Address - Fax:508-334-3819
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:ROOM S3-840
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-7177
Practice Address - Fax:508-334-3819
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist