Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 00001793 | WA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 00001793 | WA |
NPI | 1285051060 |
---|---|
Provider Name | Shelley Lois Camp |
First Address | Spokane, WA 99203-4129 |
Second Address | Spokane, WA 99203-4129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2014 |
Last Update Date | 18/03/2014 |