Provider Demographics
NPI:1841572104
Name:HENRY, PAMELA ANN (MHS, OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 ALEX WAY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8773
Mailing Address - Country:US
Mailing Address - Phone:513-755-7955
Mailing Address - Fax:
Practice Address - Street 1:5626 ALEX WAY
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-8773
Practice Address - Country:US
Practice Address - Phone:513-755-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist