Healthcare Provider Details

I. General information

NPI: 1194760934
Provider Name (Legal Business Name): PAMELA LYNNETTE SCHIELD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W MAIN ST CAMPUS BOX 440
SALEM WV
26426-1227
US

IV. Provider business mailing address

327 STOUT ST
BRIDGEPORT WV
26330-1425
US

V. Phone/Fax

Practice location:
  • Phone: 304-326-1273
  • Fax: 304-326-1516
Mailing address:
  • Phone: 304-842-6061
  • Fax: 304-326-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: