Provider Demographics
NPI:1780873299
Name:WEBER, PAMELA LOIS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LOIS
Last Name:WEBER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:LOIS
Other - Last Name:MORTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:441 W WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2131
Mailing Address - Country:US
Mailing Address - Phone:630-244-0421
Mailing Address - Fax:
Practice Address - Street 1:441 W WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2131
Practice Address - Country:US
Practice Address - Phone:630-244-0421
Practice Address - Fax:630-916-6244
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist