=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134674013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTI CAMPBELL OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2016
-----------------------------------------------------
Last Update Date | 08/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2944 DOUGLAS RD
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-641-1259
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2944 DOUGLAS RD
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-641-1259
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119006122
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------