Individual
MRS. HOLLY SUE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
317 SAXON ST, ABILENE, TX 79605-1625
(260) 760-6411
Mailing address
317 SAXON ST, ABILENE, TX 79605-1625
(260) 760-6411
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
210429
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210429
TEXAS STATE LICENSE FOR OCCUPATIONAL THERAPY ASSISTANT
TX
Enumeration date
08/09/2011
Last updated
08/09/2011
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