Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A5187 | KY |
NPI | 1003367756 |
---|---|
Provider Name | Amy Cameron |
First Address | Hawesville, KY 42348-6250 |
Second Address | Lewisport, KY 42351-7079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 18/10/2016 |