Provider Demographics
NPI:1972949337
Name:VAUGHN, PAMELA JOYCE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOYCE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JOYCE
Other - Last Name:WOLHAUPTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1056 BEACON ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3982
Mailing Address - Country:US
Mailing Address - Phone:818-519-2380
Mailing Address - Fax:
Practice Address - Street 1:1056 BEACON ST
Practice Address - Street 2:APT. 4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3982
Practice Address - Country:US
Practice Address - Phone:818-519-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist