Provider Demographics
NPI:1841395878
Name:WHITTEN, PAMELA JILL (MED OTRL)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JILL
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:MED OTRL
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JILL
Other - Last Name:ECKART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED OTRL
Mailing Address - Street 1:8720 E 105TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-398-8178
Mailing Address - Fax:
Practice Address - Street 1:4157 S HARVARD
Practice Address - Street 2:SUITE 117 THERAPY TIME
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-749-2901
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11553279OtherAETNA CAQH