Provider Demographics
NPI:1548274970
Name:CAMPBELL, KALLA A (OTR/L)
Entity type:Individual
Prefix:
First Name:KALLA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KALLA
Other - Middle Name:A
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 MEADOW BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-4315
Mailing Address - Country:US
Mailing Address - Phone:423-748-4800
Mailing Address - Fax:423-585-5889
Practice Address - Street 1:2131 WALTERS DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6903
Practice Address - Country:US
Practice Address - Phone:423-585-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist