Provider Demographics
NPI:1790459139
Name:CAMPBELL, KALEY ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3305
Mailing Address - Country:US
Mailing Address - Phone:731-819-3187
Mailing Address - Fax:
Practice Address - Street 1:145 KENNEDY DR STE B
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3341
Practice Address - Country:US
Practice Address - Phone:731-281-4407
Practice Address - Fax:731-588-5739
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist