MEDICARE: STEPHANIE NICOLE CAMERON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	105454	MN

General Provider Information

NPI Number	:	1023967890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE CAMERON

Provider Business Mailing Address
First Line	:	1583 EDGEBROOK LN
Second Line	:
City	:	CARVER
State	:	MN
Zip	:	55315-4589
Country	:	US
Telephone Number	:	320-583-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 FRANCE AVE S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1700
Country	:	US
Telephone Number	:	612-504-6402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ STEPHANIE NICOLE CAMERON ” Practice Location

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