Provider Demographics
NPI:1568718328
Name:FORD, CAMERON NICHOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:NICHOLE
Last Name:FORD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 HUNTERS TRL
Mailing Address - Street 2:APT 5
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2337
Mailing Address - Country:US
Mailing Address - Phone:336-209-1813
Mailing Address - Fax:
Practice Address - Street 1:5004 HUNTERS TRL
Practice Address - Street 2:APT 5
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:336-209-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8365224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant