Healthcare Provider Details

I. General information

NPI: 1295984151
Provider Name (Legal Business Name): PAMELA M HILEMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS PAMELA M NORRIS

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 GREEN BAY RD
KENOSHA WI
53142-3532
US

IV. Provider business mailing address

7201 GREEN BAY RD
KENOSHA WI
53142-3532
US

V. Phone/Fax

Practice location:
  • Phone: 262-694-3977
  • Fax: 262-694-5648
Mailing address:
  • Phone: 262-694-3977
  • Fax: 262-694-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1500-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: