Provider Demographics
NPI:1649790726
Name:CAMPANICKI, AMIE MARIE (ATC)
Entity type:Individual
Prefix:MS
First Name:AMIE
Middle Name:MARIE
Last Name:CAMPANICKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DUCK CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1066
Mailing Address - Country:US
Mailing Address - Phone:302-653-8581
Mailing Address - Fax:302-653-2763
Practice Address - Street 1:500 DUCK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1066
Practice Address - Country:US
Practice Address - Phone:302-653-8581
Practice Address - Fax:302-653-2763
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00001982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer