Healthcare Provider Details

I. General information

NPI: 1184955015
Provider Name (Legal Business Name): CAMIE MARIE DEAVER-BAUWENS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 TURKEYFOOT RD
ELSMERE KY
41018-2838
US

IV. Provider business mailing address

3876 TURKEYFOOT RD
ELSMERE KY
41018-2838
US

V. Phone/Fax

Practice location:
  • Phone: 859-342-8775
  • Fax: 859-342-8701
Mailing address:
  • Phone: 859-342-8775
  • Fax: 859-342-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA4206
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: