Provider Demographics
NPI:1619488277
Name:MANNING, PAMELA KAYE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAYE
Last Name:MANNING
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:KAYE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1200
Mailing Address - Country:US
Mailing Address - Phone:254-296-9792
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1200
Practice Address - Country:US
Practice Address - Phone:254-296-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214379224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant