=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821041120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA A OBERT CCCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 09/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 NORTH STREET SUITE 6 ROOM 202
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-447-2225
-----------------------------------------------------
Fax | 413-346-6798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 NORTH STREET
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-447-2225
-----------------------------------------------------
Fax | 413-346-6798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 35
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------