Provider Demographics
NPI:1962745646
Name:CAMPBELL, EMILY JEAN (OTRL)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1024
Mailing Address - Country:US
Mailing Address - Phone:408-786-7679
Mailing Address - Fax:850-244-0971
Practice Address - Street 1:266 KIDD ST
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4478
Practice Address - Country:US
Practice Address - Phone:850-582-2689
Practice Address - Fax:850-244-0971
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics