Healthcare Provider Details

I. General information

NPI: 1568380954
Provider Name (Legal Business Name): ABBY F CAMISA OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CIRCLE I RD
WILLCOX AZ
85643-3163
US

IV. Provider business mailing address

PO BOX 2724
SNOWFLAKE AZ
85937-2724
US

V. Phone/Fax

Practice location:
  • Phone: 520-507-1627
  • Fax:
Mailing address:
  • Phone: 928-863-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberOTH-010382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: