Provider Demographics
NPI:1093366882
Name:KNEBEL, PAMELA ANN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:KNEBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:TX
Mailing Address - Zip Code:77835-0068
Mailing Address - Country:US
Mailing Address - Phone:979-830-8284
Mailing Address - Fax:
Practice Address - Street 1:2106 HUISACHE ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5818
Practice Address - Country:US
Practice Address - Phone:979-203-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services