MEDICARE: AMANDA JEAN CALLOCKIO O.T.R.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201008341	MI
2	225X00000X	Occupational Therapist	OT008370	OH

General Provider Information

NPI Number	:	1316281009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JEAN CALLOCKIO O.T.R.

Provider Business Mailing Address
First Line	:	3450 W CENTRAL AVE STE 336
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1418
Country	:	US
Telephone Number	:	419-536-4247
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W CENTRAL AVE STE 336
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1418
Country	:	US
Telephone Number	:	419-536-4247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	12/04/2024

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