Provider Demographics
NPI:1972692648
Name:LOWRY, PAMELA PATAK (OT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:PATAK
Last Name:LOWRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:PATAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1708 LAKE CREST LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7440
Mailing Address - Country:US
Mailing Address - Phone:972-365-8527
Mailing Address - Fax:
Practice Address - Street 1:1708 LAKE CREST LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7440
Practice Address - Country:US
Practice Address - Phone:972-365-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10776773OtherCAQH ID
TX84P596Medicare PIN
TXTXB152622Medicare PIN