Provider Demographics
NPI:1083816995
Name:BANAY, CAMILLE (OT)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:BANAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:BANAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:951 TARA CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8882
Mailing Address - Country:US
Mailing Address - Phone:224-242-5129
Mailing Address - Fax:
Practice Address - Street 1:951 TARA CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-8882
Practice Address - Country:US
Practice Address - Phone:224-242-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9085225X00000X
IL056.009772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist