Provider Demographics
NPI:1275785172
Name:ROBINSON, CAMILLE EMIKO (DPT)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:EMIKO
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2437
Mailing Address - Country:US
Mailing Address - Phone:650-380-5264
Mailing Address - Fax:
Practice Address - Street 1:1909 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2437
Practice Address - Country:US
Practice Address - Phone:650-380-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist