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General NPI Number Information
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NPI Number | 1346758224
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Entity Type | Individual
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Provider Name | MICHELLE CAMPODONICO OTR
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Gender | Female
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Dates
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Enumeration Date | 01/13/2018
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Last Update Date | 01/13/2018
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Provider Practice Location Address
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Address Line | 4113 GATEWAY DR
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5609
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Country | US
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Telephone | 817-793-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 ROXBORO RD
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City | EULESS
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State | TX
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Zip | 76039-4034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 387385
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License Number State | TX
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