Provider Demographics
NPI:1982850343
Name:SCHALL, PAMELA ANNE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:SCHALL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:1201 OAK ST
Mailing Address - Street 2:SUITE Q
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3800
Mailing Address - Country:US
Mailing Address - Phone:262-247-0026
Mailing Address - Fax:
Practice Address - Street 1:1201 OAK ST
Practice Address - Street 2:SUITE Q
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3800
Practice Address - Country:US
Practice Address - Phone:262-247-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-16
Last Update Date:2008-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247-046171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor