MEDICARE: MRS. TARNARA CALLAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1639820467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARNARA CALLAHAM

Provider Business Mailing Address
First Line	:	290 OAK GROVE DR
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-2715
Country	:	US
Telephone Number	:	434-509-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 OAK GROVE DR
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-2715
Country	:	US
Telephone Number	:	434-509-5245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	01/13/2022

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Directions to “ MRS. TARNARA CALLAHAM ” Practice Location

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