Provider Demographics
NPI:1477892255
Name:CALLAHAN, MICHAEL A (OT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 LAZY OAK LN
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2577
Mailing Address - Country:US
Mailing Address - Phone:609-978-8768
Mailing Address - Fax:
Practice Address - Street 1:227 LAZY OAK LN
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2577
Practice Address - Country:US
Practice Address - Phone:609-978-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00074000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist