Healthcare Provider Details

I. General information

NPI: 1316526502
Provider Name (Legal Business Name): CASSIDY TAYLOR CAMPBELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 PIPER STATION DR STE 103
CHARLOTTE NC
28277-6690
US

IV. Provider business mailing address

5113 PIPER STATION DR STE 103
CHARLOTTE NC
28277-6690
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-1616
  • Fax: 704-759-0799
Mailing address:
  • Phone: 704-752-1616
  • Fax: 704-759-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13718
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: