Provider Demographics
NPI:1780053645
Name:STEPHENSON, PAM (OTD, MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:OTD, 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 1:1591 PORT REPUBLIC ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1591 PORT REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3517
Practice Address - Country:US
Practice Address - Phone:540-437-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-01-14
Deactivation Date:2015-11-10
Deactivation Code:
Reactivation Date:2016-01-14
Provider Licenses
StateLicense IDTaxonomies
VA0119004626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist