Provider Demographics
NPI:1356575419
Name:CAMP, CAROL S (CAROL CAMP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:CAMP
Suffix:
Gender:F
Credentials:CAROL CAMP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2523 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5429
Mailing Address - Country:US
Mailing Address - Phone:941-917-0260
Mailing Address - Fax:
Practice Address - Street 1:2523 ROSE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5429
Practice Address - Country:US
Practice Address - Phone:941-917-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 6776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist