Individual
MRS. LIBBY CHANEL CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4101 W ILES AVE, SPRINGFIELD, IL 62711-7051
(217) 793-9429
Mailing address
4101 W ILES AVE, SPRINGFIELD, IL 62711-7051
(217) 823-4099
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005444
IL
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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