Provider Demographics
NPI:1780569020
Name:SPEED-HENLEY, CAMERON (BCTMB, LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:SPEED-HENLEY
Suffix:
Gender:M
Credentials:BCTMB, LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 DARTMOUTH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5123
Mailing Address - Country:US
Mailing Address - Phone:508-426-9180
Mailing Address - Fax:
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:WATUPPA BLDG, #101
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-426-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125330225700000X
RIMT02918225700000X
MA18265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist