Provider Demographics
NPI:1508494626
Name:CALO, JARED RYAN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:RYAN
Last Name:CALO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E BROADWAY RD APT 1180
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1557
Mailing Address - Country:US
Mailing Address - Phone:602-341-8445
Mailing Address - Fax:
Practice Address - Street 1:1720 E BROADWAY RD APT 1180
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1557
Practice Address - Country:US
Practice Address - Phone:602-341-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007151224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant