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Individual
MRS. PAMELA MOORE WYCKOFF
Active
Individual
MRS. PAMELA MOORE WYCKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC003029L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017878950001
—
PA
Enumeration date
04/17/2007
Last updated
06/12/2012
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