Provider Demographics
NPI:1366641342
Name:CAMPBELL, CAROL ANN (COTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 WEST GRANT ST
Mailing Address - Street 2:PO 254
Mailing Address - City:SLATEDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18079
Mailing Address - Country:US
Mailing Address - Phone:610-760-8394
Mailing Address - Fax:
Practice Address - Street 1:701 SLATE BELT BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-9341
Practice Address - Country:US
Practice Address - Phone:610-599-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006218224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant