Provider Demographics
NPI:1710356514
Name:MCCAMPBELL, GAYLE (OTR)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:MCCAMPBELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3 NICOLLE LN
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-5174
Mailing Address - Country:US
Mailing Address - Phone:208-940-0740
Mailing Address - Fax:
Practice Address - Street 1:3 NICOLLE LN
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-5174
Practice Address - Country:US
Practice Address - Phone:208-940-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist