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NPI Code Detail

MEDICARE: CASSIDY TAYLOR CAMPBELL OTR/L

MEDICARE:   CASSIDY TAYLOR 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
1225XP0200XPediatric Occupational Therapist13718NC

General Provider Information

NPI Number : 1316526502
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY TAYLOR CAMPBELL OTR/L
Provider Business Mailing Address
First Line : 5113 PIPER STATION DR STE 103
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6690
Country : US
Telephone Number : 704-752-1616
Fax Number : 704-759-0799
Provider Business Practice Location Address
First Line : 5113 PIPER STATION DR STE 103
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-6690
Country : US
Telephone Number : 704-752-1616
Fax Number : 704-759-0799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2021
Last Update Date : 05/05/2021

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Directions to “ CASSIDY TAYLOR CAMPBELL OTR/L” Practice Location

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