Provider Demographics
NPI:1730317843
Name:CAMPBELL, DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CAMPBELL
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 1:2592 E GRAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-5915
Mailing Address - Country:US
Mailing Address - Phone:847-265-1460
Mailing Address - Fax:847-265-1650
Practice Address - Street 1:2592 E GRAND AVE STE 209
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-5915
Practice Address - Country:US
Practice Address - Phone:847-265-1460
Practice Address - Fax:847-265-1650
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist