Provider Demographics
NPI:1265250807
Name:DICKERSON, CAMBRI (COTA/L)
Entity type:Individual
Prefix:
First Name:CAMBRI
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 W CANNON PARK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9328
Mailing Address - Country:US
Mailing Address - Phone:801-205-3269
Mailing Address - Fax:
Practice Address - Street 1:5284 S COMMERCE DR STE C214
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5568
Practice Address - Country:US
Practice Address - Phone:549-280-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12354645-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant