Provider Demographics
NPI:1083130199
Name:CAMPBELL, ROSE (OT-C)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 N ORLANDO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6219
Mailing Address - Country:US
Mailing Address - Phone:602-281-5841
Mailing Address - Fax:
Practice Address - Street 1:649 NORTH ORLANDO
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:602-281-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL030817050156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist