Provider Demographics
NPI:1740600592
Name:EGELUND, PAM (CTRS, TRS)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:
Last Name:EGELUND
Suffix:
Gender:F
Credentials:CTRS, TRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 W ELK HORN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6426
Mailing Address - Country:US
Mailing Address - Phone:801-633-1060
Mailing Address - Fax:
Practice Address - Street 1:2815 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2820
Practice Address - Country:US
Practice Address - Phone:801-293-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7944252-4002225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist