MEDICARE: MISS CAMILLE STACEY-ANN ROWE COTA/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	224Z00000X	Occupational Therapy Assistant	14220	FL

General Provider Information

NPI Number	:	1588220420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAMILLE STACEY-ANN ROWE COTA/L

Provider Business Mailing Address
First Line	:	10749 NW 40TH ST
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-8262
Country	:	US
Telephone Number	:	954-562-2957
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 SANDESTIN LN
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-5815
Country	:	US
Telephone Number	:	954-562-2957
Fax Number	:

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

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	05/16/2019

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