Healthcare Provider Details

I. General information

NPI: 1649466178
Provider Name (Legal Business Name): ANDREA LEA MCCALLISTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA LEA GRAY OTR/L

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 01/17/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S HIGHWAY 27 SEARAY COUNTY SCHOOL DISTRICT
MARSHALL AR
72650-7638
US

IV. Provider business mailing address

PO DRAWER 2109
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-5976
  • Fax: 870-448-3542
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-967-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2136
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: