Provider Demographics
NPI:1508057472
Name:CAMPANELLA, AMY LOUISE (BS IN OT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:CAMPANELLA
Suffix:
Gender:F
Credentials:BS IN OT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:WERENCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1565 SAXON BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5876
Mailing Address - Country:US
Mailing Address - Phone:386-851-0901
Mailing Address - Fax:386-851-2426
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-851-0901
Practice Address - Fax:386-851-2426
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT #8475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist