Provider Demographics
NPI:1003367756
Name:CAMERON, AMY (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STUMP NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-6250
Mailing Address - Country:US
Mailing Address - Phone:270-903-7738
Mailing Address - Fax:
Practice Address - Street 1:8005 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-7079
Practice Address - Country:US
Practice Address - Phone:270-295-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA5187224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant