Provider Demographics
NPI:1013549609
Name:DECKER, CAMMY RENE' (LMT)
Entity Type:Individual
Prefix:
First Name:CAMMY
Middle Name:RENE'
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CAMMY
Other - Middle Name:R
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:56 STONEGATE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8896
Mailing Address - Country:US
Mailing Address - Phone:614-949-8428
Mailing Address - Fax:
Practice Address - Street 1:801 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71901-5315
Practice Address - Country:US
Practice Address - Phone:614-949-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty