Healthcare Provider Details

I. General information

NPI: 1750618112
Provider Name (Legal Business Name): PAMELA STOTTMAN CM, BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 SW 11TH ST
LAWTON OK
73501-7305
US

IV. Provider business mailing address

PO BOX 662
PURCELL OK
73080-0662
US

V. Phone/Fax

Practice location:
  • Phone: 580-581-1818
  • Fax: 580-581-1819
Mailing address:
  • Phone: 405-527-1785
  • Fax: 405-527-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: