Healthcare Provider Details

I. General information

NPI: 1649581539
Provider Name (Legal Business Name): CALLIE RENEE PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-4081
  • Fax: 859-224-4082
Mailing address:
  • Phone: 859-224-4081
  • Fax: 859-224-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: