Provider Demographics
NPI:1871748541
Name:CAMPBELL, MICHELLE M (LMT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FIDDLERS LN
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5341
Mailing Address - Country:US
Mailing Address - Phone:518-229-0362
Mailing Address - Fax:
Practice Address - Street 1:637 NEW LOUDON RD
Practice Address - Street 2:BAYBERRY SQUARE RT 9
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4077
Practice Address - Country:US
Practice Address - Phone:518-229-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021585174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist