Provider Demographics
NPI:1992471544
Name:CAMPOS, KEVIN (OTD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8832
Mailing Address - Country:US
Mailing Address - Phone:630-945-4907
Mailing Address - Fax:
Practice Address - Street 1:1901 SILVER GLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3351
Practice Address - Country:US
Practice Address - Phone:224-276-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056.014379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist