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General NPI Number Information
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NPI Number | 1558772541
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Entity Type | Organization
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Legal Business Name | CAMERON THERAPIES, LLC
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 809 PARKLAND DR
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City | CLOVIS
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State | NM
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Zip | 88101-4474
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Country | US
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Telephone | 806-928-2436
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Fax |
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Provider Business Mailing Address
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Address Line | 501 MONTICELLO PARKWAY DR
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City | PORTALES
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State | NM
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Zip | 88130-8200
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Country | US
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Telephone | 806-928-2436
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Fax |
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Authorized Official
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Title or Position | OWNER/SECRETARY
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Name | MR. RUSSELL W CAMERON
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Credential | MPT
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Telephone | 806-928-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 3292
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 1525
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5171
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 5169
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License Number State | NM
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