1902908239 NPI number — MS. PAMELA SUE SEGAL OTR/L

Table of content: MS. PAMELA SUE SEGAL OTR/L (NPI 1902908239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902908239 NPI number — MS. PAMELA SUE SEGAL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGAL
Provider First Name:
PAMELA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902908239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12644 SHORELINE DR APT 8G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-889-1522
Provider Business Mailing Address Fax Number:
954-316-9239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SE 19TH AVE
Provider Second Line Business Practice Location Address:
BROWARD CHILDREN'S CENTER
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-587-2497
Provider Business Practice Location Address Fax Number:
954-943-4115
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT8552 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 886776300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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