Provider Demographics
NPI:1457695553
Name:MARSH, PAM (COF)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-3629
Mailing Address - Country:US
Mailing Address - Phone:910-582-1776
Mailing Address - Fax:910-557-5662
Practice Address - Street 1:41 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-3629
Practice Address - Country:US
Practice Address - Phone:910-582-1776
Practice Address - Fax:910-557-5662
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC50918225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter