Basic Information
| Provider Information | |||||||||
| NPI: | 1871797290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | AUDRA | ||||||||
| MiddleName: | LOWE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8301 BUSHLAND RD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062702521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 MEDI PARK DR | ||||||||
| Address2: | SUITE 2048 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791062110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063532101 | ||||||||
| FaxNumber: | 8063532674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 111559 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.