Provider Demographics
NPI:1730388851
Name:HENRY, CAMMEE CECILIA (COTA)
Entity type:Individual
Prefix:MS
First Name:CAMMEE
Middle Name:CECILIA
Last Name:HENRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4092 REDCASTLE PL
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7853
Mailing Address - Country:US
Mailing Address - Phone:618-975-2845
Mailing Address - Fax:
Practice Address - Street 1:4092 REDCASTLE PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-7853
Practice Address - Country:US
Practice Address - Phone:618-975-2845
Practice Address - Fax:618-332-7710
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002408224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant