Provider Demographics
NPI:1285846170
Name:SACARNY, CAMERON BOHN
Entity type:Individual
Prefix:MS
First Name:CAMERON
Middle Name:BOHN
Last Name:SACARNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRANDVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7504
Mailing Address - Country:US
Mailing Address - Phone:781-646-9446
Mailing Address - Fax:
Practice Address - Street 1:10 GRANDVIEW ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-7504
Practice Address - Country:US
Practice Address - Phone:781-646-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703885Medicaid
MA0703885Medicaid