Individual
MRS. STACIE R CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2380 BUFFALO RD, LAWRENCEBURG, TN 38464-4809
(931) 762-9418
Mailing address
29 CROSS ROAD, ETHRIDGE, TN 38456
(931) 829-2480
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1139
TN
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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