Provider Demographics
NPI:1033562269
Name:CAMACHO MARTINEZ, ANGELICA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:CAMACHO MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 ROTONDA CIR
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2127
Mailing Address - Country:US
Mailing Address - Phone:260-452-6730
Mailing Address - Fax:941-460-4494
Practice Address - Street 1:1116 ROTONDA CIR
Practice Address - Street 2:
Practice Address - City:ROTONDA WEST
Practice Address - State:FL
Practice Address - Zip Code:33947-2127
Practice Address - Country:US
Practice Address - Phone:260-452-6730
Practice Address - Fax:941-460-4494
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002114A224Z00000X
FLOT24660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant