Basic Information
| Provider Information | |||||||||
| NPI: | 1548274970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | KALLA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | HELM | ||||||||
| OtherFirstName: | KALLA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 307 MEADOW BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | BEAN STATION | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377084315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237484800 | ||||||||
| FaxNumber: | 4235855889 | ||||||||
| Practice Location | |||||||||
| Address1: | 2131 WALTERS DR | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378146903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235850544 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3340 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.