Provider Demographics
NPI:1114679768
Name:HALSTEAD, PAMELA FAY (TVI/COMS)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:FAY
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:TVI/COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 TOM TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8876
Mailing Address - Country:US
Mailing Address - Phone:606-521-2642
Mailing Address - Fax:
Practice Address - Street 1:1906 GOLDSMITH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2066
Practice Address - Country:US
Practice Address - Phone:502-498-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000038777222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist