Healthcare Provider Details

I. General information

NPI: 1588852321
Provider Name (Legal Business Name): PAM MCCUTCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 8TH AVE
STILLWATER OK
74074-4602
US

IV. Provider business mailing address

116 W 8TH AVE
STILLWATER OK
74074-4602
US

V. Phone/Fax

Practice location:
  • Phone: 405-624-8605
  • Fax: 405-624-8606
Mailing address:
  • Phone: 405-624-8605
  • Fax: 405-624-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2004018373
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1109
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: