Provider Demographics
NPI:1871172148
Name:CAMPBELL, JILL MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16355 W POST DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-2174
Mailing Address - Country:US
Mailing Address - Phone:480-392-5986
Mailing Address - Fax:
Practice Address - Street 1:16355 W POST DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2174
Practice Address - Country:US
Practice Address - Phone:480-392-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTA-006347OtherCOTA/L