Provider Demographics
NPI:1154447621
Name:CAMPAGNA, MICHELLE S (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:CAMPAGNA
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 1:4 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1872
Mailing Address - Country:US
Mailing Address - Phone:603-880-6923
Mailing Address - Fax:
Practice Address - Street 1:20 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-6631
Practice Address - Country:US
Practice Address - Phone:603-532-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1525225X00000X
MA8084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist