Provider Demographics
NPI:1477860062
Name:CAMPANELLA, JOAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:CAMPANELLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SQUIRREL HL
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2843
Mailing Address - Country:US
Mailing Address - Phone:516-627-4908
Mailing Address - Fax:
Practice Address - Street 1:23 SQUIRREL HL
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2843
Practice Address - Country:US
Practice Address - Phone:516-627-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist