Provider Demographics
NPI:1649807827
Name:HEAD, PAMELA JOANE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOANE
Last Name:HEAD
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 1:1846 WHITES BEND LN
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-6153
Mailing Address - Country:US
Mailing Address - Phone:931-268-3987
Mailing Address - Fax:
Practice Address - Street 1:120 PITCOCK LN
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4058
Practice Address - Country:US
Practice Address - Phone:931-243-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1994224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant