Healthcare Provider Details

I. General information

NPI: 1508669821
Provider Name (Legal Business Name): CALLIE ELIZABETH VAUGHN OTR/L, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 TESSON FERRY RD STE B
SAINT LOUIS MO
63128-2908
US

IV. Provider business mailing address

102 SUGAR BEND CT
SAINT PETERS MO
63376-7420
US

V. Phone/Fax

Practice location:
  • Phone: 314-696-0707
  • Fax:
Mailing address:
  • Phone: 618-922-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2025008639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: