MEDICARE: CARLY CALTON

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	224Z00000X	Occupational Therapy Assistant	2025027402

General Provider Information

NPI Number	:	1427949395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY CALTON

Provider Business Mailing Address
First Line	:	360 S ARCHER AVE
Second Line	:
City	:	HARTVILLE
State	:	MO
Zip	:	65667-8217
Country	:	US
Telephone Number	:	417-259-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 COUNTY ROAD 1270
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793-3393
Country	:	US
Telephone Number	:	417-259-7875
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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Directions to “ CARLY CALTON ” Practice Location

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