Provider Demographics
NPI:1558732685
Name:CAMERON, NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:KARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 LAURENCE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2979
Mailing Address - Country:US
Mailing Address - Phone:517-750-4777
Mailing Address - Fax:269-792-2847
Practice Address - Street 1:1001 LAURENCE AVE COMPREHENSIVE SPEECH AND THERAPY CENT
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2979
Practice Address - Country:US
Practice Address - Phone:517-750-4777
Practice Address - Fax:269-792-2847
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2019-04-24
Deactivation Date:2019-03-24
Deactivation Code:
Reactivation Date:2019-04-24
Provider Licenses
StateLicense IDTaxonomies
MI5201009327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist