MEDICARE: MADISON GRACE CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119011413	VA

General Provider Information

NPI Number	:	1700715273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON GRACE CAMPBELL

Provider Business Mailing Address
First Line	:	1605 NEWTON ST
Second Line	:
City	:	BRISTOL
State	:	VA
Zip	:	24201-3747
Country	:	US
Telephone Number	:	276-791-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 WOLF CREEK TRL
Second Line	:
City	:	ABINGDON
State	:	VA
Zip	:	24210-2536
Country	:	US
Telephone Number	:	276-388-9483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ MADISON GRACE CAMPBELL ” Practice Location

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