Provider Demographics
NPI:1780948562
Name:PARKER, PAMELA KAY (OT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21186 E LIBERTY PL
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:85145-5036
Mailing Address - Country:US
Mailing Address - Phone:520-370-1482
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 9100
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-9744
Practice Address - Country:US
Practice Address - Phone:520-361-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist