Healthcare Provider Details

I. General information

NPI: 1295563740
Provider Name (Legal Business Name): JASMINE N CAMPBELL OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 HARBOUR VIEW BLVD STE 108B
SUFFOLK VA
23435-2764
US

IV. Provider business mailing address

8620 BRUSHFOOT WAY UNIT 101
RALEIGH NC
27616-3910
US

V. Phone/Fax

Practice location:
  • Phone: 757-974-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17000
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number17000
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: