Provider Demographics
NPI:1982782462
Name:SMITH, PAMELA ROSE (LSW, COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 ROYAL OAK CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3546
Mailing Address - Country:US
Mailing Address - Phone:419-543-2226
Mailing Address - Fax:
Practice Address - Street 1:210 E MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1246
Practice Address - Country:US
Practice Address - Phone:330-262-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH522424104100000X
OHOTA.05079224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker