Provider Demographics
NPI:1164267654
Name:DISS, CAMRYN (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:
Last Name:DISS
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 72ND ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7949
Mailing Address - Country:US
Mailing Address - Phone:231-838-9646
Mailing Address - Fax:
Practice Address - Street 1:2831 RINGLING BLVD STE E120
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5353
Practice Address - Country:US
Practice Address - Phone:941-955-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist