Provider Demographics
NPI:1982819975
Name:CAMERON, SANDRA L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:CAMERON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 EAST RD
Mailing Address - Street 2:BERLIN
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-5392
Mailing Address - Country:US
Mailing Address - Phone:802-223-6919
Mailing Address - Fax:
Practice Address - Street 1:136 EAST RD
Practice Address - Street 2:BERLIN
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5392
Practice Address - Country:US
Practice Address - Phone:802-223-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000321174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist