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NPI Code Detail

MEDICARE: MRS. CALLIE DARTLON FREELAND LCOTA

MEDICARE: MRS. CALLIE DARTLON FREELAND LCOTA
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
1224Z00000XOccupational Therapy Assistant325856LA

General Provider Information

NPI Number : 1750114591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CALLIE DARTLON FREELAND LCOTA
Provider Business Mailing Address
First Line : 266 TURNER RD
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8073
Country : US
Telephone Number : 318-418-5640
Fax Number :
Provider Business Practice Location Address
First Line : 5445 HIGHWAY 2
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-8365
Country : US
Telephone Number : 318-428-4025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2024
Last Update Date : 08/26/2024

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