Basic Information
| Provider Information | |||||||||
| NPI: | 1891756722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITTHAUS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69030 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212649030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 6970 FOX HUNT LN | ||||||||
| Address2: | |||||||||
| City: | GLOUCESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230615394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046948111 | ||||||||
| FaxNumber: | 8046945574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119002323 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 192945 | 01 | VA | BCBS (OCCUPATIONAL THERAPY) | OTHER | 11446180 | 01 | VA | CAQH | OTHER | 7596331 | 01 | VA | AETNA | OTHER | P00651588 | 01 | VA | RAILROAD MEDICARE | OTHER | 1891756722 | 05 | VA | MEDICAID |