Provider Demographics
NPI:1104034677
Name:MATTOX, PAMELA MICHELLE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELLE
Last Name:MATTOX
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HAZEL TREE LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7737
Mailing Address - Country:US
Mailing Address - Phone:606-678-0921
Mailing Address - Fax:
Practice Address - Street 1:375 HAZEL TREE LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-7737
Practice Address - Country:US
Practice Address - Phone:606-780-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist