Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2882 | CO |
NPI | 1184282204 |
---|---|
Provider Name | Debora Semeliss Campbell |
First Address | Windsor, CO 80550-4679 |
Second Address | Windsor, CO 80550-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 04/06/2019 |