Healthcare Provider Details

I. General information

NPI: 1881951812
Provider Name (Legal Business Name): JODIE ANN CALLAHAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A LOISDALE ROAD
SPRINGFIELD VA
22150-3053
US

IV. Provider business mailing address

8208 SMITHFIELD AVE
SPRINGFIELD VA
22152-3053
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-0602
  • Fax:
Mailing address:
  • Phone: 703-451-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119001236
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: