Provider Demographics
NPI:1992059596
Name:CAM, ELENA (LMT)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:CAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6882 BIRCHWOOD CT N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:559 GLATT CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9675
Practice Address - Country:US
Practice Address - Phone:503-981-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist