Provider Demographics
NPI:1013124148
Name:CAMPIS, ROSE CORALY NIEVES (OT)
Entity Type:Individual
Prefix:MRS
First Name:ROSE CORALY
Middle Name:NIEVES
Last Name:CAMPIS
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:COL. DE PEDERNALES # 3
Mailing Address - Street 2:LOS MARTINEZ
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-310-5105
Mailing Address - Fax:
Practice Address - Street 1:3 COLS DE PEDERNALES
Practice Address - Street 2:LOS MARTINEZ
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4359
Practice Address - Country:US
Practice Address - Phone:787-310-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR673225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics