Provider Demographics
NPI:1952645707
Name:CROUCH, PAMELA REGINA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:REGINA
Last Name:CROUCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 CAJAH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-9580
Mailing Address - Country:US
Mailing Address - Phone:828-499-0359
Mailing Address - Fax:
Practice Address - Street 1:1361 CAJAH MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-9580
Practice Address - Country:US
Practice Address - Phone:828-499-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1962224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant