Healthcare Provider Details

I. General information

NPI: 1376199968
Provider Name (Legal Business Name): CAMERON HANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMRYN HANDLER

II. Dates (important events)

Enumeration Date: 08/10/2019
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 MOORSBRIDGE RD STE A
PORTAGE MI
49024-7417
US

IV. Provider business mailing address

6361 ROTHBURY ST
PORTAGE MI
49024-2376
US

V. Phone/Fax

Practice location:
  • Phone: 269-312-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: