Individual
PAMELA J ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 SAINT LOUIS AVE, FORT WORTH, TX 76104-3324
(817) 332-9962
Mailing address
701 SAINT LOUIS AVE, FORT WORTH, TX 76104-3324
(817) 332-9962
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
206711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206711
MANAGED CARE
TX
05
—
206711
—
TX
Enumeration date
08/21/2018
Last updated
08/21/2018
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