Provider Demographics
NPI:1124064217
Name:CAMPBELL, ERIN L (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEE
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:17121 CLEMENTINE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2496
Mailing Address - Country:US
Mailing Address - Phone:704-641-7193
Mailing Address - Fax:
Practice Address - Street 1:5700 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 115
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8858
Practice Address - Country:US
Practice Address - Phone:704-566-6040
Practice Address - Fax:704-525-9337
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11313122OtherCAQH