Provider Demographics
NPI:1588220420
Name:ROWE, CAMILLE STACEY-ANN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:STACEY-ANN
Last Name:ROWE
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 1:10749 NW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8262
Mailing Address - Country:US
Mailing Address - Phone:954-562-2957
Mailing Address - Fax:
Practice Address - Street 1:138 SANDESTIN LN
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-5815
Practice Address - Country:US
Practice Address - Phone:954-562-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14220224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant