Provider Demographics
NPI:1689792517
Name:COON, PAMELA ELAINE (LMT, NCTMB)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ELAINE
Last Name:COON
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 OLD STATE ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3316
Mailing Address - Country:US
Mailing Address - Phone:513-646-4193
Mailing Address - Fax:513-724-5279
Practice Address - Street 1:4592 MONTGOMERY ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3118
Practice Address - Country:US
Practice Address - Phone:513-985-5455
Practice Address - Fax:513-891-7286
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33012396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist