Provider Demographics
NPI:1487942983
Name:KETCHEL, PAMELA CHRISTINE (CMT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:KETCHEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2299
Mailing Address - Country:US
Mailing Address - Phone:810-599-6486
Mailing Address - Fax:
Practice Address - Street 1:204 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2299
Practice Address - Country:US
Practice Address - Phone:810-599-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
154742OtherAMTA