MEDICARE: MRS. PAMELA ANNE HOGUE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	101912	TX

General Provider Information

NPI Number	:	1154573475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA ANNE HOGUE OTR

Provider Business Mailing Address
First Line	:	4800 BRANCHVIEW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1363
Country	:	US
Telephone Number	:	817-483-5413
Fax Number	:	817-483-5413

Provider Business Practice Location Address
First Line	:	4800 BRANCHVIEW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1363
Country	:	US
Telephone Number	:	817-483-5413
Fax Number	:	817-483-5413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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