Provider Demographics
NPI:1881880276
Name:WILLIAMS, PAMELA (COTA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 E 950 N
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9446
Mailing Address - Country:US
Mailing Address - Phone:219-926-8387
Mailing Address - Fax:847-441-0734
Practice Address - Street 1:110 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9368
Practice Address - Country:US
Practice Address - Phone:219-926-8387
Practice Address - Fax:847-441-0734
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000416A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant