Provider Demographics
NPI:1548736457
Name:CUNNINGHAM, PAMELA OUTLAND (OTRL)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:OUTLAND
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9 CAMBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1104
Mailing Address - Country:US
Mailing Address - Phone:248-506-1418
Mailing Address - Fax:248-629-4704
Practice Address - Street 1:9 CAMBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1104
Practice Address - Country:US
Practice Address - Phone:248-506-1418
Practice Address - Fax:248-629-4704
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XN1300X
MI225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation