Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0T2220 | FL |
N | 225XM0800X | Mental Health | 0T2220 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0T2220 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 0T2220 | FL |
NPI | 1881970788 |
---|---|
Provider Name | Carlene Campbell-Diaz |
First Address | Pinecrest, FL 33256-6601 |
Second Address | South Miami, FL 33143-5428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2011 |
Last Update Date | 09/01/2020 |