Provider Demographics
NPI:1881710481
Name:CAMERON, MARLENA JOANNE (MPT, OSC)
Entity type:Individual
Prefix:MS
First Name:MARLENA
Middle Name:JOANNE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MPT, OSC
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:JOANNE
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, OCS
Mailing Address - Street 1:1111 S BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6682
Mailing Address - Country:US
Mailing Address - Phone:805-922-1711
Mailing Address - Fax:805-361-0186
Practice Address - Street 1:201 N COLLEGE DR STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-922-1724
Practice Address - Fax:805-922-2765
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33540225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33540AMedicare PIN