Provider Demographics
NPI:1821490806
Name:CAMERON, BROOK (LMT, HHP)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 STANDISH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3126
Mailing Address - Country:US
Mailing Address - Phone:810-956-4937
Mailing Address - Fax:
Practice Address - Street 1:1901 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4806
Practice Address - Country:US
Practice Address - Phone:810-956-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist