Provider Demographics
NPI:1447527510
Name:STOLL, PAMELA C (OTR/L)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:C
Last Name:STOLL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1459
Mailing Address - Country:US
Mailing Address - Phone:513-312-9515
Mailing Address - Fax:864-308-1337
Practice Address - Street 1:801 RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1459
Practice Address - Country:US
Practice Address - Phone:513-312-9515
Practice Address - Fax:864-308-1337
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist