Provider Demographics
NPI:1336596576
Name:SHERLOG, PAMELA MUELLER (COTA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MUELLER
Last Name:SHERLOG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2314 TINNEY PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3709
Mailing Address - Country:US
Mailing Address - Phone:615-491-5950
Mailing Address - Fax:
Practice Address - Street 1:2314 TINNEY PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3709
Practice Address - Country:US
Practice Address - Phone:615-491-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant