Provider Demographics
NPI:1548381296
Name:CAMPBELL, DARLA LYNN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1315
Mailing Address - Country:US
Mailing Address - Phone:580-747-5036
Mailing Address - Fax:
Practice Address - Street 1:2501 MERCER DR
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-8602
Practice Address - Country:US
Practice Address - Phone:580-233-0650
Practice Address - Fax:580-249-5999
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1404174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist