Provider Demographics
NPI:1669805909
Name:O'HANLON, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:O'HANLON
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 1:1623 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2509
Mailing Address - Country:US
Mailing Address - Phone:954-440-0179
Mailing Address - Fax:954-440-0182
Practice Address - Street 1:1623 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2509
Practice Address - Country:US
Practice Address - Phone:954-440-0179
Practice Address - Fax:954-440-0182
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist