Provider Demographics
NPI:1720547730
Name:CAMPBELL, EMILY (BS ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BS ATC, LAT
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS ATC, LAT
Mailing Address - Street 1:3727 ANDREWS HWY APT 2801
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-6316
Mailing Address - Country:US
Mailing Address - Phone:432-894-2348
Mailing Address - Fax:
Practice Address - Street 1:1301 N DOTSY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-3597
Practice Address - Country:US
Practice Address - Phone:432-456-0203
Practice Address - Fax:432-456-0207
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT74582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer