Provider Demographics
NPI:1336489186
Name:MIZE, CALLIE MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:MARIE
Last Name:MIZE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:CALLIE
Other - Middle Name:MARIE
Other - Last Name:SPECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:752 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8319
Mailing Address - Country:US
Mailing Address - Phone:317-851-8087
Mailing Address - Fax:
Practice Address - Street 1:303 N HURSTBOURNE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5185
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002634A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist