Provider Demographics
NPI:1003168881
Name:AUDET, CALLIE ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ELIZABETH
Last Name:AUDET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ELIZABETH
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2312
Mailing Address - Country:US
Mailing Address - Phone:330-827-1551
Mailing Address - Fax:
Practice Address - Street 1:2100 38TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2312
Practice Address - Country:US
Practice Address - Phone:330-827-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012549225X00000X
OHOT.008197225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist