=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104740265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN CALLAWAY OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 LAURA ST
-----------------------------------------------------
City | STARKE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32091-4026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-964-3383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 694 SE 4TH AVE
-----------------------------------------------------
City | MELROSE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32666-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-626-6731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------