Provider Demographics
NPI:1467739664
Name:CAMPBELL, KARA BETH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:BETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1947
Mailing Address - Country:US
Mailing Address - Phone:812-381-3275
Mailing Address - Fax:
Practice Address - Street 1:702 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1947
Practice Address - Country:US
Practice Address - Phone:812-381-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001682A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer