Provider Demographics
NPI:1184287609
Name:CAMPBELL, ANAIS MABELL (OTR)
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:MABELL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ANAIS
Other - Middle Name:M
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:405 MATHEWS ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2909
Mailing Address - Country:US
Mailing Address - Phone:970-818-8866
Mailing Address - Fax:
Practice Address - Street 1:405 MATHEWS ST UNIT A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2909
Practice Address - Country:US
Practice Address - Phone:970-818-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist