Individual
MS. PAMELA CORPUS PAGUIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
252 LATITUDE LN STE 103, LAKE WYLIE, SC 29710-8152
(803) 818-0218
Mailing address
252 LATITUDE LN STE 103, LAKE WYLIE, SC 29710-8152
(803) 631-5483
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
110280
TX
225X00000X
Occupational Therapist
11464
NC
225X00000X
Occupational Therapist
Primary
5137
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157093901
—
TX
01
—
86356T
BLUE CROSS BLUE SHIELD
TX
05
—
TH3210
—
SC
Enumeration date
12/08/2006
Last updated
02/01/2019
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