Provider Demographics
NPI:1538570650
Name:CAMPANERIA, KATHERINE (MS, ATC, CEAS)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:CAMPANERIA
Suffix:
Gender:F
Credentials:MS, ATC, CEAS
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:3506 5TH AVE NE # B202
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-3291
Mailing Address - Country:US
Mailing Address - Phone:330-719-2352
Mailing Address - Fax:
Practice Address - Street 1:6399 E HARVEST RIDGE DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5580
Practice Address - Country:US
Practice Address - Phone:330-719-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT31412255A2300X
ND833-192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer