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General NPI Number Information
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NPI Number | 1538851076
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Entity Type | Individual
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Provider Name | CALLIE DAMAZO OTA/L
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Gender | Female
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 18350 CROSSING DR
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City | TINLEY PARK
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State | IL
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Zip | 60487-6294
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Country | US
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Telephone | 708-342-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAMPSHIRE CT UNIT 102B
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City | NAPERVILLE
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State | IL
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Zip | 60565-3291
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Country | US
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Telephone | 708-800-6241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057006001
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License Number State | IL
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