Provider Demographics
NPI:1275941890
Name:DOST, PAMELA (ATC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DOST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S CAMP RD
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9727
Mailing Address - Country:US
Mailing Address - Phone:906-361-4577
Mailing Address - Fax:
Practice Address - Street 1:820 CARP RIVER LN STE 2
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3187
Practice Address - Country:US
Practice Address - Phone:906-204-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010001732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer