Provider Demographics
NPI:1992054027
Name:BACKES, PAMELA RAE (MOT OTR/L)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:BACKES
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 AMINDA ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-2455
Mailing Address - Country:US
Mailing Address - Phone:913-441-0284
Mailing Address - Fax:
Practice Address - Street 1:4409 AMINDA ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-2455
Practice Address - Country:US
Practice Address - Phone:913-441-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist