Provider Demographics
NPI:1558595603
Name:MCCALLUM, JUDITH T (OTR)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:T
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5702
Mailing Address - Country:US
Mailing Address - Phone:703-750-2443
Mailing Address - Fax:
Practice Address - Street 1:1481 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5702
Practice Address - Country:US
Practice Address - Phone:703-750-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000493225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119000493OtherOT LICENSE