Provider Demographics
NPI:1881171932
Name:TRAVERS, PAMELA JEAN (DS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436R MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1106
Mailing Address - Country:US
Mailing Address - Phone:617-429-6132
Mailing Address - Fax:
Practice Address - Street 1:8 HENSHAW ST STE F
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4679
Practice Address - Country:US
Practice Address - Phone:617-429-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist