Basic Information
| Provider Information | |||||||||
| NPI: | 1831105196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCANN-FLORES | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTL/R | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1390 | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294651390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438847880 | ||||||||
| FaxNumber: | 8438846635 | ||||||||
| Practice Location | |||||||||
| Address1: | 2093 HENRY TECKLENBURG DR | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439582500 | ||||||||
| FaxNumber: | 8439582689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 1036 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | GP1753 | 05 | SC | MEDICAID |