Provider Demographics
NPI:1457904617
Name:ROLLE, CAMERON LAMAR
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:LAMAR
Last Name:ROLLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5641
Mailing Address - Country:US
Mailing Address - Phone:561-236-6269
Mailing Address - Fax:
Practice Address - Street 1:2110 SE MADISON ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5641
Practice Address - Country:US
Practice Address - Phone:561-236-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist