Provider Demographics
NPI:1558482174
Name:CAMERON, TERESA M (LMT,NCMT,AC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LMT,NCMT,AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1832
Mailing Address - Country:US
Mailing Address - Phone:315-528-3799
Mailing Address - Fax:
Practice Address - Street 1:609 CANTON ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3811
Practice Address - Country:US
Practice Address - Phone:315-528-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist