Healthcare Provider Details

I. General information

NPI: 1902952914
Provider Name (Legal Business Name): PAMELA MARIE MARSHALL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

IV. Provider business mailing address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-619-3984
  • Fax: 859-224-4675
Mailing address:
  • Phone: 859-619-3984
  • Fax: 859-224-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number135225
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: