Healthcare Provider Details

I. General information

NPI: 1144544172
Provider Name (Legal Business Name): CAMELOT OUTPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RIDGEWAY ROAD
NORRIS TN
37828
US

IV. Provider business mailing address

4207 E HWY 290
DRIPPING SPRINGS TX
78620-4206
US

V. Phone/Fax

Practice location:
  • Phone: 512-858-9900
  • Fax: 512-858-9901
Mailing address:
  • Phone: 865-494-5554
  • Fax: 865-494-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES LONG
Title or Position: SENIOR VP & CFO
Credential:
Phone: 512-858-9900