Healthcare Provider Details

I. General information

NPI: 1598340226
Provider Name (Legal Business Name): CAMI LEWIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 SLIDE RD
LUBBOCK TX
79424-1329
US

IV. Provider business mailing address

2611 GANNON ST
LUBBOCK TX
79415-9777
US

V. Phone/Fax

Practice location:
  • Phone: 806-686-0429
  • Fax:
Mailing address:
  • Phone: 817-791-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number121645
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: