Provider Demographics
NPI:1629532858
Name:SHIREY, CALLIE JANELLE
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:JANELLE
Last Name:SHIREY
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 1:621 STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2114
Mailing Address - Country:US
Mailing Address - Phone:254-495-5945
Mailing Address - Fax:
Practice Address - Street 1:621 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-2114
Practice Address - Country:US
Practice Address - Phone:254-495-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117486225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics