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Individual

TERESA LEA CAMPBELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA L

Contact information

Practice address
10300 W 103RD ST, SUITE 300, OVERLAND PARK, KS 66214-2642
(913) 894-1910
Mailing address
1604 DUNWICH DR, LIBERTY, MO 64068-3216
(816) 792-1168

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
004876
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
004876
MISSOURI LICENSE
MO
Enumeration date
06/27/2007
Last updated
07/08/2007
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