Provider Demographics
NPI:1003341462
Name:SPECK, CALEY O'CALLAGHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CALEY
Middle Name:O'CALLAGHAN
Last Name:SPECK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CALEY
Other - Middle Name:
Other - Last Name:O'CALLAGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 S GLOSTER ST STE C
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6548
Mailing Address - Country:US
Mailing Address - Phone:662-432-1523
Mailing Address - Fax:
Practice Address - Street 1:1211 S GLOSTER ST STE C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6548
Practice Address - Country:US
Practice Address - Phone:662-432-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS359701225X00000X
MSOT-3234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist