Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 17-00036 | KS |
NPI | 1003038985 |
---|---|
Provider Name | Denise M Campbell |
First Address | Shawnee, KS 66216-3103 |
Second Address | Shawnee, KS 66216-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |