Provider Demographics
NPI:1427526771
Name:OCAMPO, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:OCAMPO
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 1:9402 TAWNYBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5663
Mailing Address - Country:US
Mailing Address - Phone:407-276-1978
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:9402 TAWNYBERRY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5663
Practice Address - Country:US
Practice Address - Phone:407-276-1978
Practice Address - Fax:407-483-9551
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-17-31765OtherBEHAVIOR ANALISYS CERTIFICATION BOARD
FL020609900Medicaid