Basic Information
Provider Information
NPI: 1003007568
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEARLES
FirstName: PAMELA
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 159 BENNETT DR
Address2:  
City: CARIBOU
State: ME
PostalCode: 047362049
CountryCode: US
TelephoneNumber: 2074983820
FaxNumber: 2074983591
Practice Location
Address1: 57 PIONEER AVE
Address2:  
City: CARIBOU
State: ME
PostalCode: 047362440
CountryCode: US
TelephoneNumber: 2074933089
FaxNumber: 2077236785
Other Information
ProviderEnumerationDate: 08/08/2007
LastUpdateDate: 09/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XN1300XOT564MEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation

No ID Information.


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