Provider Demographics
NPI:1609045129
Name:CAMERON, JENNIFER JAYNE (ATC/L)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JAYNE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3503
Mailing Address - Country:US
Mailing Address - Phone:954-247-0011
Mailing Address - Fax:954-247-0122
Practice Address - Street 1:7600 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3503
Practice Address - Country:US
Practice Address - Phone:954-247-0011
Practice Address - Fax:954-247-0122
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 22572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer