Provider Demographics
NPI:1598267858
Name:CAMPBELL, KALI
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 S LAMAR BLVD APT 1821
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7951
Mailing Address - Country:US
Mailing Address - Phone:706-763-0167
Mailing Address - Fax:
Practice Address - Street 1:3816 S LAMAR BLVD APT 1821
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7951
Practice Address - Country:US
Practice Address - Phone:706-763-0167
Practice Address - Fax:833-895-2077
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118758225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist