Provider Demographics
NPI:1669447462
Name:GOUDZWAARD, PAMELA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GOUDZWAARD
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 SYLVAN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1535 44TH ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4481
Practice Address - Country:US
Practice Address - Phone:616-530-1977
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000826225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand