Provider Demographics
NPI:1083220115
Name:CAMPBELL, MARJORIE ROSE (COTA)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ROSE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 SPRING VALLEY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2512
Mailing Address - Country:US
Mailing Address - Phone:214-466-1340
Mailing Address - Fax:214-466-1378
Practice Address - Street 1:5220 SPRING VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2512
Practice Address - Country:US
Practice Address - Phone:214-466-1340
Practice Address - Fax:214-466-1378
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216365224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty