MEDICARE: MS. CAMERON MARY PLAGENS MAATR

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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1942351325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAMERON MARY PLAGENS MAATR

Provider Business Mailing Address
First Line	:	24308 BRUCE RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-2938
Country	:	US
Telephone Number	:	440-773-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	30400 DETROIT RD STE 105
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-871-6700
Fax Number	:

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	08/31/2023

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