Provider Demographics
NPI:1275305419
Name:CAMPOLI, KATHERINE (BS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CAMPOLI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15724 AUTRY CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-4236
Mailing Address - Country:US
Mailing Address - Phone:813-943-7003
Mailing Address - Fax:
Practice Address - Street 1:49 UNIVERSITY DR # 421
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:VT
Practice Address - Zip Code:05735-4515
Practice Address - Country:US
Practice Address - Phone:813-943-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer