Healthcare Provider Details

I. General information

NPI: 1114401452
Provider Name (Legal Business Name): CALLI KAHL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2018
Last Update Date: 09/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CORAL CT STE 1
CORALVILLE IA
52241-2837
US

IV. Provider business mailing address

2517 OKLAHOMA AVE
DAVENPORT IA
52804-4628
US

V. Phone/Fax

Practice location:
  • Phone: 319-853-0596
  • Fax:
Mailing address:
  • Phone: 563-676-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number093319
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: