Provider Demographics
NPI:1942907944
Name:OETKEN, CAMBRIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAMBRIA
Middle Name:
Last Name:OETKEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BOONE RIDGE DR APT 133
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-5020
Mailing Address - Country:US
Mailing Address - Phone:805-914-8814
Mailing Address - Fax:
Practice Address - Street 1:1800 BRIDGEGATE ST
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1448
Practice Address - Country:US
Practice Address - Phone:805-285-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
TN14758225100000X
CA305452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist