Individual
PAMELA JO ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
21106 SR 410 E, BONNEY LAKE, WA 98391-8788
(425) 264-8401
Mailing address
560 N MCNEELY ST, BUCKLEY, WA 98321-9279
(701) 429-8044
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
60437067
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT60437067
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
07/08/2022
Last updated
07/08/2022
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