Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1664 | WV |
N | 225XH1200X | Occupational Therapist - Hand | 1664 | WV |
NPI | 1265931646 |
---|---|
Provider Name | Pamela Grzadzielewski |
First Address | Martinsburg, WV 25403-0868 |
Second Address | Martinsburg, WV 25405-9990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 12/02/2018 |