Provider Demographics
NPI:1780164905
Name:BUCHANNON, PAMELA SHANELL (OT/L)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SHANELL
Last Name:BUCHANNON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 LAFAYE CT
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-1170
Mailing Address - Country:US
Mailing Address - Phone:334-498-0359
Mailing Address - Fax:
Practice Address - Street 1:1690 N TREADAWAY BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3051
Practice Address - Country:US
Practice Address - Phone:325-701-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117845225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist