Provider Demographics
NPI:1811250186
Name:LEVANDOSKI, PAMELA JOAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOAN
Last Name:LEVANDOSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:JOAN
Other - Last Name:PELENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2557 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6238
Mailing Address - Country:US
Mailing Address - Phone:732-701-3711
Mailing Address - Fax:732-701-3709
Practice Address - Street 1:2557 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6238
Practice Address - Country:US
Practice Address - Phone:732-701-3711
Practice Address - Fax:732-701-3709
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09005100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant