Provider Demographics
NPI:1184262685
Name:CHIESI, CAMRON (DPT, OTR/L)
Entity type:Individual
Prefix:MR
First Name:CAMRON
Middle Name:
Last Name:CHIESI
Suffix:
Gender:M
Credentials:DPT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RYMSHAW PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6401
Mailing Address - Country:US
Mailing Address - Phone:219-614-1984
Mailing Address - Fax:
Practice Address - Street 1:324 WILDER BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-6025
Practice Address - Country:US
Practice Address - Phone:219-614-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17887225X00000X
FLPT33190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist