Provider Demographics
NPI:1346601408
Name:CAMPBELL, EMILY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 UNIVERSITY DRIVE
Mailing Address - Street 2:PEGULA ICE ARENA
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-441-5313
Mailing Address - Fax:
Practice Address - Street 1:250 UNIVERSITY DRIVE
Practice Address - Street 2:PEGULA ICE ARENA
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-441-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer