Provider Demographics
NPI:1891942124
Name:OWEN, PAMELA JEAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2172
Mailing Address - Country:US
Mailing Address - Phone:425-870-3834
Mailing Address - Fax:360-794-4853
Practice Address - Street 1:809 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2172
Practice Address - Country:US
Practice Address - Phone:425-870-3834
Practice Address - Fax:360-794-4853
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60037468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist