MEDICARE: MR. CAMERON HOLMES OTR/L

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	225X00000X	Occupational Therapist	OT009575	OH

General Provider Information

NPI Number	:	1255873287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CAMERON HOLMES OTR/L

Provider Business Mailing Address
First Line	:	13450 CEDAR RD APT 27
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2961
Country	:	US
Telephone Number	:	517-416-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	14900 PRIVATE DR
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3470
Country	:	US
Telephone Number	:	216-851-8200
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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