Provider Demographics
NPI:1609174440
Name:MCCALLEN, CAROL L (OT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:MCCALLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:LOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12445 GARRETT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4922
Mailing Address - Country:US
Mailing Address - Phone:901-619-7006
Mailing Address - Fax:
Practice Address - Street 1:600 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4934
Practice Address - Country:US
Practice Address - Phone:901-287-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4312225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation