Provider Demographics
NPI:1932525508
Name:CAMPBELL, ELIZABETH MEGHANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MEGHANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KELLER SMITHFIELD RD S
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2188
Mailing Address - Country:US
Mailing Address - Phone:682-593-0730
Mailing Address - Fax:
Practice Address - Street 1:200 KELLER SMITHFIELD RD S
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2188
Practice Address - Country:US
Practice Address - Phone:682-593-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist