Healthcare Provider Details

I. General information

NPI: 1346958832
Provider Name (Legal Business Name): CAMERON PRINGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD # 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

900 GRANGE HALL DR APT 3208
EULESS TX
76039-1916
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 407-952-2145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: