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General NPI Number Information
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NPI Number | 1750629184
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Entity Type | Individual
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Provider Name | AMANDA ELLEN CAMPO MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/29/2017
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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 | 2428 MONTE CARLO WAY APT 625
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City | FORT WORTH
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State | TX
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Zip | 76244-1487
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Country | US
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Telephone | 631-965-2589
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 017786
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 117332
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License Number State | TX
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