Provider Demographics
NPI:1063967941
Name:KOENIG, PAMELA (LMT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5724 BABYGOLD CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-3478
Mailing Address - Country:US
Mailing Address - Phone:513-484-5013
Mailing Address - Fax:
Practice Address - Street 1:6531 WINFORD AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-0548
Practice Address - Country:US
Practice Address - Phone:513-863-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist