Healthcare Provider Details

I. General information

NPI: 1851213540
Provider Name (Legal Business Name): ELIZABETH CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 OLD MONROE RD STE E
INDIAN TRAIL NC
28079-5415
US

IV. Provider business mailing address

8432 DAWSON LN
LOCUST NC
28097-9418
US

V. Phone/Fax

Practice location:
  • Phone: 704-686-7767
  • Fax:
Mailing address:
  • Phone: 843-300-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number18653
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: