Individual
MS. PAM GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2400 N CARROLL AVE, SOUTHLAKE, TX 76092-3105
(817) 949-7050
Mailing address
2400 N CARROLL AVE, SOUTHLAKE, TX 76092-3105
(817) 846-1370
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
111643
TX
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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