Provider Demographics
NPI:1528198603
Name:PITCOCK, EMILY DAWN (MED)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DAWN
Last Name:PITCOCK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9711
Mailing Address - Country:US
Mailing Address - Phone:270-791-2759
Mailing Address - Fax:270-780-2177
Practice Address - Street 1:203 SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9711
Practice Address - Country:US
Practice Address - Phone:270-791-2759
Practice Address - Fax:270-780-2177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist