Provider Demographics
NPI:1467856617
Name:VAUSE, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:VAUSE
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 1:1836 JOHN HEATH RD.
Mailing Address - Street 2:
Mailing Address - City:DEEP RUN
Mailing Address - State:NC
Mailing Address - Zip Code:28525
Mailing Address - Country:US
Mailing Address - Phone:252-525-8300
Mailing Address - Fax:252-686-6915
Practice Address - Street 1:1836 JOHN HEATH RD
Practice Address - Street 2:
Practice Address - City:DEEP RUN
Practice Address - State:NC
Practice Address - Zip Code:28525-9578
Practice Address - Country:US
Practice Address - Phone:252-525-8300
Practice Address - Fax:252-686-6915
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NC1406612252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist