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General NPI Number Information
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NPI Number | 1881970788
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Entity Type | Individual
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Provider Name | CARLENE CAMPBELL-DIAZ OT, CLT
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Gender | Female
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 7600 SW 57TH AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 786-295-7101
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 566601
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City | PINECREST
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State | FL
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Zip | 33256-6601
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Country | US
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Telephone | 786-295-7101
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 0T2220
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | 0T2220
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0T2220
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0T2220
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License Number State | FL
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