Provider Demographics
NPI:1306570791
Name:CAMEL, ALICIA A
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:CAMEL
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:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0742
Mailing Address - Country:US
Mailing Address - Phone:406-270-6891
Mailing Address - Fax:
Practice Address - Street 1:3800 OLEARY ST APT 301
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1593
Practice Address - Country:US
Practice Address - Phone:406-270-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer