Provider Demographics
NPI:1083011589
Name:GARRISON, PAMELA DENISE (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DENISE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2825
Mailing Address - Country:US
Mailing Address - Phone:203-441-3064
Mailing Address - Fax:855-635-5245
Practice Address - Street 1:17 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-2825
Practice Address - Country:US
Practice Address - Phone:203-441-3064
Practice Address - Fax:855-635-5245
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist