Healthcare Provider Details

I. General information

NPI: 1265683361
Provider Name (Legal Business Name): JEANNE CAMPBELL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

PO BOX 225
MOUNTAINVILLE NY
10953-0225
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-2395
  • Fax:
Mailing address:
  • Phone: 845-614-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007202-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: