Provider Demographics
NPI:1437749553
Name:CAMPBELL, HANNAH NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:NICOLE
Other - Last Name:KENWORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 SWEETGUM TRL
Mailing Address - Street 2:
Mailing Address - City:LAUREL PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28739-9514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2811
Practice Address - Country:US
Practice Address - Phone:828-697-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13219OtherNORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY
433818OtherNATIONAL BOARD OF OCCUPATIONAL THERAPY