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General NPI Number Information
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NPI Number | 1679559850
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Entity Type | Individual
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Provider Name | LEISHA CALLAN OTR
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 1311 FORT ST SUITE L
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City | BARLING
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State | AR
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Zip | 72923-2045
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Country | US
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Telephone | 479-965-5086
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Fax | 877-694-8824
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Provider Business Mailing Address
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Address Line | 201 CEDAR LN
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City | CHARLESTON
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State | AR
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Zip | 72933-9499
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Country | US
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Telephone | 479-965-5086
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Fax | 877-694-8824
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR275
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License Number State | AR
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