Provider Demographics
NPI:1316526502
Name:CAMPBELL, CASSIDY TAYLOR (OTR/L)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:TAYLOR
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 1:5113 PIPER STATION DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6690
Mailing Address - Country:US
Mailing Address - Phone:704-752-1616
Mailing Address - Fax:704-759-0799
Practice Address - Street 1:5113 PIPER STATION DR STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6690
Practice Address - Country:US
Practice Address - Phone:704-752-1616
Practice Address - Fax:704-759-0799
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13718225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics