MEDICARE: PAMELA L. SLAGG ITDS, M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1154464881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA L. SLAGG ITDS, M.ED.

Provider Business Mailing Address
First Line	:	4315 W SAN PEDRO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7707
Country	:	US
Telephone Number	:	813-832-9481
Fax Number	:	813-832-9481

Provider Business Practice Location Address
First Line	:	4315 W SAN PEDRO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7707
Country	:	US
Telephone Number	:	813-832-9481
Fax Number	:	813-832-9481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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