Provider Demographics
NPI:1013792035
Name:CAMPBELL, ANNALEESA FAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNALEESA
Middle Name:FAY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:FAY
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST STE 109D
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4892
Mailing Address - Country:US
Mailing Address - Phone:509-554-5565
Mailing Address - Fax:509-381-3524
Practice Address - Street 1:104 S FREYA ST STE 109D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4892
Practice Address - Country:US
Practice Address - Phone:509-554-5565
Practice Address - Fax:509-381-3524
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61404929225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics