Provider Demographics
NPI:1184962946
Name:CAMPBELL, ALYSSA BERRY (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BERRY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4891
Mailing Address - Country:US
Mailing Address - Phone:423-722-2062
Mailing Address - Fax:423-722-2063
Practice Address - Street 1:1975 W ELK AVE STE 1
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3787
Practice Address - Country:US
Practice Address - Phone:423-722-2062
Practice Address - Fax:423-722-2063
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4697225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist