Provider Demographics
NPI:1285397943
Name:CAMPBELL, KARLY (MSOTRL)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 RITCHIE HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4133
Mailing Address - Country:US
Mailing Address - Phone:410-421-8920
Mailing Address - Fax:
Practice Address - Street 1:836 RITCHIE HWY STE 6
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4133
Practice Address - Country:US
Practice Address - Phone:410-421-8920
Practice Address - Fax:410-421-8923
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09436225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist