Provider Demographics
NPI:1619464849
Name:GROOMS, PAMELA SUE (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:GROOMS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 ELAM RD APT F209
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6170
Mailing Address - Country:US
Mailing Address - Phone:615-604-0619
Mailing Address - Fax:
Practice Address - Street 1:928 OLD SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-6805
Practice Address - Country:US
Practice Address - Phone:931-473-8431
Practice Address - Fax:931-473-8936
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN784225X00000X
TN0784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist