Healthcare Provider Details

I. General information

NPI: 1669812152
Provider Name (Legal Business Name): KRISTIN A CAMPBELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 26TH AVE
MONROE WI
53566-1531
US

IV. Provider business mailing address

516 26TH AVE
MONROE WI
53566-1531
US

V. Phone/Fax

Practice location:
  • Phone: 608-329-6600
  • Fax: 608-329-6594
Mailing address:
  • Phone: 608-329-6600
  • Fax: 608-329-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5344-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: