Provider Demographics
NPI:1467165753
Name:O'CALLAGHAN, MARY LEGRANGE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEGRANGE
Last Name:O'CALLAGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5403
Mailing Address - Country:US
Mailing Address - Phone:225-244-1954
Mailing Address - Fax:
Practice Address - Street 1:153 KELLY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5403
Practice Address - Country:US
Practice Address - Phone:225-244-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist