MEDICARE: MS. SHELLEY SCOTT CAMPBELL OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	8823	NC
2	225XP0019X	Physical Rehabilitation Occupational Therapist	2432	FL

General Provider Information

NPI Number	:	1144659293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY SCOTT CAMPBELL OTR/L

Provider Business Mailing Address
First Line	:	2615 COLGATE LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6315
Country	:	US
Telephone Number	:	561-667-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 COLGATE LN
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6315
Country	:	US
Telephone Number	:	561-667-2615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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