Individual
MS. PAMELA WELLINGTON MIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3000 N RIDGE RD, ELLICOTT CITY, MD 21043-3311
(443) 366-4499
(443) 736-7480
Mailing address
32521 MOUNT HERMON RD, PARSONSBURG, MD 21849-2064
(443) 366-4499
(443) 736-7480
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A00490
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A00490
MARYLAND BOARD OF OCCUPATIONAL THERAPY
MD
Enumeration date
02/08/2012
Last updated
02/08/2012
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