Provider Demographics
NPI:1225705486
Name:CALLAHAN, CYNTHIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CALLAHAN
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 1:2118 EASTWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1175
Mailing Address - Country:US
Mailing Address - Phone:804-852-5575
Mailing Address - Fax:
Practice Address - Street 1:300 TWINRIDGE LN
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5282
Practice Address - Country:US
Practice Address - Phone:804-594-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist