Provider Demographics
NPI:1780036335
Name:BROWN, PAMELA JEANNETTE (TVI)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEANNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 RUSSELL BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-8650
Mailing Address - Country:US
Mailing Address - Phone:606-348-4457
Mailing Address - Fax:
Practice Address - Street 1:310 RUSSELL BROWN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-8650
Practice Address - Country:US
Practice Address - Phone:606-348-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist