Provider Demographics
NPI:1245279280
Name:CAMPBELL, CARA K (OTD, MED, OTR-L)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTD, MED, OTR-L
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, MED, OTR-L
Mailing Address - Street 1:8294 S PLACITA DEL BARQUERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9122
Mailing Address - Country:US
Mailing Address - Phone:520-574-1306
Mailing Address - Fax:520-326-3552
Practice Address - Street 1:8294 S PLACITA DEL BARQUERO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9122
Practice Address - Country:US
Practice Address - Phone:520-574-1306
Practice Address - Fax:520-326-3552
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0192225XN1300X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ537392Medicaid