Provider Demographics
NPI:1285970038
Name:RATTAI-GANN, PAMELA R (OTR)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:RATTAI-GANN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 ORION LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9010
Mailing Address - Country:US
Mailing Address - Phone:763-639-9355
Mailing Address - Fax:
Practice Address - Street 1:11951 GRANDHAVEN DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7843
Practice Address - Country:US
Practice Address - Phone:843-357-0200
Practice Address - Fax:952-955-2010
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1001225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist