Provider Demographics
NPI:1568694123
Name:CAMPBELL, JAMES D
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 N NODAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4643
Mailing Address - Country:US
Mailing Address - Phone:717-283-6701
Mailing Address - Fax:
Practice Address - Street 1:4390 BELLE OAKS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8559
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3410225X00000X
MO2019037835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist