Provider Demographics
NPI:1427797182
Name:WOOD, PAMELA BETH (MA, LAT, ATR)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:BETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA, LAT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4657 NE KILLINGSWORTH ST UNIT 37
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1947
Mailing Address - Country:US
Mailing Address - Phone:503-708-9751
Mailing Address - Fax:
Practice Address - Street 1:4035 NE SANDY BLVD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5331
Practice Address - Country:US
Practice Address - Phone:971-940-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORART-T-10207954221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORART-T-10207954OtherLICENSED ART THERAPIST