Provider Demographics
NPI:1558368118
Name:TUTTEN, PAMELA MARY (OT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARY
Last Name:TUTTEN
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MARY
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, CHT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:190 OLD ORCHARD SQ
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8172
Practice Address - Country:US
Practice Address - Phone:706-273-3131
Practice Address - Fax:706-273-3133
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2278225XH1200X
GAOT005043225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0187OtherBLUE CROSS BLUE SHIELD
FLZ0187OtherBLUE CROSS BLUE SHIELD