Healthcare Provider Details

I. General information

NPI: 1104740265
Provider Name (Legal Business Name): JEAN CALLAWAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 LAURA ST
STARKE FL
32091-4026
US

IV. Provider business mailing address

694 SE 4TH AVE
MELROSE FL
32666-5426
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-3383
  • Fax:
Mailing address:
  • Phone: 252-626-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: