Provider Demographics
NPI:1699727206
Name:WOLFE, PAMELA (OT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:
Practice Address - Street 1:394 S GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3099
Practice Address - Country:US
Practice Address - Phone:831-786-9000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOT270300Medicaid
CAZZZ28496ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER