Individual
KELLY RENEE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
7901 S 12TH ST, SUITE #200, PORTAGE, MI 49024-3831
(269) 372-7200
Mailing address
7901 S 12TH ST, SUITE #200, PORTAGE, MI 49024-3831
(269) 372-7200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007870
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5201007870
LICENSE
MN
Enumeration date
06/16/2011
Last updated
06/16/2011
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