Provider Demographics
NPI:1093016586
Name:CAMPBELL, KATHERINE JEAN-THOMAS (OTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JEAN-THOMAS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KILLDEER DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7200
Mailing Address - Country:US
Mailing Address - Phone:910-270-8722
Mailing Address - Fax:
Practice Address - Street 1:2744 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6606
Practice Address - Country:US
Practice Address - Phone:910-794-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6383224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant