Provider Demographics
NPI:1871797290
Name:CAMPBELL, AUDRA LOWE (OTR)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:LOWE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 BUSHLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6825
Mailing Address - Country:US
Mailing Address - Phone:706-270-2521
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 2048
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-353-2101
Practice Address - Fax:806-353-2674
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist