Provider Demographics
NPI:1548512296
Name:LEBLANC, PAMELA J (OTR/L)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:LEBLANC
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 1:20 ENWRIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1648
Mailing Address - Country:US
Mailing Address - Phone:508-279-0966
Mailing Address - Fax:
Practice Address - Street 1:25 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1911
Practice Address - Country:US
Practice Address - Phone:781-269-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist