Provider Demographics
NPI:1750635819
Name:CAMERON, MIKAILA NICOLE (LAC, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MIKAILA
Middle Name:NICOLE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LAC, OTR/L
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:JEANINE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10925 SABRE HILL DR UNIT 380
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4185
Mailing Address - Country:US
Mailing Address - Phone:858-663-7614
Mailing Address - Fax:
Practice Address - Street 1:10925 SABRE HILL DR UNIT 380
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4185
Practice Address - Country:US
Practice Address - Phone:858-663-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14996171100000X
CA7370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist