Provider Demographics
NPI:1669856779
Name:CALLIS, CHRIS L
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:L
Last Name:CALLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29202 PIN OAK WAY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4647
Mailing Address - Country:US
Mailing Address - Phone:443-480-6377
Mailing Address - Fax:
Practice Address - Street 1:29202 PIN OAK WAY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4647
Practice Address - Country:US
Practice Address - Phone:443-480-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services