Provider Demographics
NPI:1033752514
Name:CAMELO, MOLLY ROSE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ROSE
Last Name:CAMELO
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 1:375 SWAINS POND AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-5811
Mailing Address - Country:US
Mailing Address - Phone:781-710-2792
Mailing Address - Fax:
Practice Address - Street 1:375 SWAINS POND AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-5811
Practice Address - Country:US
Practice Address - Phone:781-710-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer