Provider Demographics
NPI:1558368118
Name:TUTTEN, PAMELA MARY (OT, CHT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARY
Last Name:TUTTEN
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MARY
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, CHT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:1520 SUNDAY DR STE 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5254
Practice Address - Country:US
Practice Address - Phone:919-420-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2278225XH1200X
GAOT005043225XH1200X
NC13470225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0187OtherBLUE CROSS BLUE SHIELD
FLZ0187OtherBLUE CROSS BLUE SHIELD