Individual
KATHRYNE CAMMISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
310 BARNWELL AVE NE, AIKEN, SC 29801-4406
(803) 641-4144
(804) 641-4147
Mailing address
1216 WINTER ST, AUGUSTA, GA 30904-4418
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000368
GA
225X00000X
Occupational Therapist
SC216
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000634389E
—
GA
01
—
10033920
AMERIGROUP
GA
01
—
318108
WELLCARE
GA
05
—
PH0015
—
SC
Enumeration date
12/12/2006
Last updated
08/17/2017
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