Provider Demographics
NPI:1780054338
Name:STOCKDALE, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:STOCKDALE
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 1:2751 ARBOR AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7791 COOPER RD
Practice Address - Street 2:STE. H
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7734
Practice Address - Country:US
Practice Address - Phone:513-793-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer