Provider Demographics
NPI:1003157611
Name:MCCANN, PAMELA M
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 TAMPA RD UNIT 284
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-9713
Mailing Address - Country:US
Mailing Address - Phone:727-485-4660
Mailing Address - Fax:727-789-9204
Practice Address - Street 1:3905 TAMPA RD UNIT 284
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-9713
Practice Address - Country:US
Practice Address - Phone:727-485-4660
Practice Address - Fax:727-789-9204
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist