Provider Demographics
NPI:1841668415
Name:PETERS, CAMILLE (OT/L)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 TURTLE RUN BLVD
Mailing Address - Street 2:#724
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4207
Mailing Address - Country:US
Mailing Address - Phone:786-223-7139
Mailing Address - Fax:
Practice Address - Street 1:9580 LAKE SERENA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-6517
Practice Address - Country:US
Practice Address - Phone:786-223-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003418225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist