Provider Demographics
NPI:1427039981
Name:KOTILA, PAMELA M (MS,PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:KOTILA
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5285 NE ELAM YOUNG PKWY
Mailing Address - Street 2:STE A100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6459
Mailing Address - Country:US
Mailing Address - Phone:503-621-3280
Mailing Address - Fax:503-693-7000
Practice Address - Street 1:527 SE 9TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4605
Practice Address - Country:US
Practice Address - Phone:503-681-2340
Practice Address - Fax:503-693-7000
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic