Provider Demographics
NPI:1861922668
Name:CAMPBELL, KALI
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6298 COUNTY HWY E
Mailing Address - Street 2:
Mailing Address - City:TREGO
Mailing Address - State:WI
Mailing Address - Zip Code:54888-9307
Mailing Address - Country:US
Mailing Address - Phone:715-416-3280
Mailing Address - Fax:
Practice Address - Street 1:W6298 COUNTY HWY E
Practice Address - Street 2:
Practice Address - City:TREGO
Practice Address - State:WI
Practice Address - Zip Code:54888-9307
Practice Address - Country:US
Practice Address - Phone:715-416-3280
Practice Address - Fax:715-416-3280
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant