Provider Demographics
NPI:1417291899
Name:CAMPBELL, SUZY
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:801 ALHAMBRA BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4432
Mailing Address - Country:US
Mailing Address - Phone:916-248-9174
Mailing Address - Fax:916-457-5646
Practice Address - Street 1:801 ALHAMBRA BLVD
Practice Address - Street 2:STE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4432
Practice Address - Country:US
Practice Address - Phone:916-248-9174
Practice Address - Fax:916-457-5646
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics