Provider Demographics
NPI:1962754994
Name:CAMPBELL, KAREN MICHELE (OTR/L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELE
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:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-0381
Mailing Address - Country:US
Mailing Address - Phone:509-445-0654
Mailing Address - Fax:
Practice Address - Street 1:305 MONUMENTAL WAY
Practice Address - Street 2:
Practice Address - City:CUSICK
Practice Address - State:WA
Practice Address - Zip Code:99119
Practice Address - Country:US
Practice Address - Phone:509-445-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00003585225XP0200X
IDOT-719225XP0200X
OR437475225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics