Provider Demographics
NPI:1164689485
Name:GOATLEY, PAMELA ANN (DEVELOPMENTAL INTERV)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:GOATLEY
Suffix:
Gender:F
Credentials:DEVELOPMENTAL INTERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 STATE ROUTE 440
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:KY
Mailing Address - Zip Code:42051-9222
Mailing Address - Country:US
Mailing Address - Phone:270-674-5529
Mailing Address - Fax:270-623-6393
Practice Address - Street 1:4989 STATE ROUTE 440
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:KY
Practice Address - Zip Code:42051-9222
Practice Address - Country:US
Practice Address - Phone:270-674-5529
Practice Address - Fax:270-623-6393
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF19527M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist