Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 3747 | CA |
NPI | 1013279934 |
---|---|
Provider Name | Melissa Jean Cameron |
First Address | Campbell, CA 95008-0550 |
Second Address | Campbell, CA 95008-0550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 15/06/2012 |