Provider Demographics
NPI:1710388517
Name:SMITH, CAMERON
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 MILL CIR
Mailing Address - Street 2:APT. 98
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5100
Mailing Address - Country:US
Mailing Address - Phone:440-213-2188
Mailing Address - Fax:
Practice Address - Street 1:980 MILL CIR
Practice Address - Street 2:APT. 98
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5100
Practice Address - Country:US
Practice Address - Phone:440-213-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer