Provider Demographics
NPI:1538486873
Name:RYAN, PAMELA S (OTR)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:906 INDIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2006
Mailing Address - Country:US
Mailing Address - Phone:314-395-3215
Mailing Address - Fax:
Practice Address - Street 1:289 IRELAND AVE HEADQUARTERS US ARMY MEDICAL DEPARTMENT
Practice Address - Street 2:IRELAND HOSPITAL OCCUPATIONAL THERAPY DEPT.
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5520
Practice Address - Country:US
Practice Address - Phone:502-624-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009011528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist