Provider Demographics
NPI:1740411917
Name:BASOM, PAMELA R
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:BASOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5222 BURNET RD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2432
Mailing Address - Country:US
Mailing Address - Phone:512-302-4838
Mailing Address - Fax:512-302-4268
Practice Address - Street 1:5222 BURNET RD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2432
Practice Address - Country:US
Practice Address - Phone:512-302-4838
Practice Address - Fax:512-302-4268
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter