Provider Demographics
NPI:1891326468
Name:WALDROP, CAMERRON (LMT)
Entity Type:Individual
Prefix:
First Name:CAMERRON
Middle Name:
Last Name:WALDROP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2866 CRESCENT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7423
Mailing Address - Country:US
Mailing Address - Phone:541-654-5499
Mailing Address - Fax:
Practice Address - Street 1:2866 CRESCENT AVE STE 105
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7423
Practice Address - Country:US
Practice Address - Phone:541-654-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-24662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty