MEDICARE: PAMELA S. RYAN OTR

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	225X00000X	Occupational Therapist	2009011528	MO

General Provider Information

NPI Number	:	1538486873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA S. RYAN OTR

Provider Business Mailing Address
First Line	:	906 INDIAN HILLS DR
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2006
Country	:	US
Telephone Number	:	314-395-3215
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 IRELAND AVE HEADQUARTERS US ARMY MEDICAL DEPARTMENT
Second Line	:	IRELAND HOSPITAL OCCUPATIONAL THERAPY DEPT.
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5520
Country	:	US
Telephone Number	:	502-624-9007
Fax Number	:

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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