1528183803 NPI number — MRS. LAURA JOAN CAMERON OTR/L

Table of content: MRS. LAURA JOAN CAMERON OTR/L (NPI 1528183803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528183803 NPI number — MRS. LAURA JOAN CAMERON OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMERON
Provider First Name:
LAURA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUMONT
Provider Other First Name:
LAURA
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528183803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 PALERMO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METHUEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01844-5827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-655-3082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 CHICKERING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-681-9397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  9268 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)