Provider Demographics
NPI:1427274604
Name:MLAGAN, PAMALA ANNE (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:ANNE
Last Name:MLAGAN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:PAMALA
Other - Middle Name:ANNE
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:1280 S 600 W
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-9459
Mailing Address - Country:US
Mailing Address - Phone:765-336-4475
Mailing Address - Fax:
Practice Address - Street 1:1280 S 600 W
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-9459
Practice Address - Country:US
Practice Address - Phone:765-336-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003865A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200688540AMedicare UPIN