Provider Demographics
NPI:1073768081
Name:MCCALL, ROBERTA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6622
Mailing Address - Country:US
Mailing Address - Phone:978-855-8534
Mailing Address - Fax:
Practice Address - Street 1:1626 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6622
Practice Address - Country:US
Practice Address - Phone:978-855-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19894225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist