Provider Demographics
NPI:1114357290
Name:CAMPBELL, LISA (OTR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6956
Mailing Address - Country:US
Mailing Address - Phone:317-815-0778
Mailing Address - Fax:317-815-0781
Practice Address - Street 1:11550 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6956
Practice Address - Country:US
Practice Address - Phone:317-815-0778
Practice Address - Fax:317-815-0781
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003338A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist