Provider Demographics
NPI:1497369433
Name:BRANCH, CAMILLE GABRIELLE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:GABRIELLE
Last Name:BRANCH
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 1:733 BRASSIE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6418
Mailing Address - Country:US
Mailing Address - Phone:252-883-1171
Mailing Address - Fax:
Practice Address - Street 1:733 BRASSIE CLUB DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6418
Practice Address - Country:US
Practice Address - Phone:252-883-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist