Provider Demographics
NPI:1710210497
Name:CALLINS, STACIE M (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:M
Last Name:CALLINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BUTTERMILK LN
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-8636
Mailing Address - Country:US
Mailing Address - Phone:731-587-9746
Mailing Address - Fax:
Practice Address - Street 1:180 MT. PELIA RD.
Practice Address - Street 2:HEALTHSOUTH CANE CREEK REHAB. HOSPITAL
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237
Practice Address - Country:US
Practice Address - Phone:731-587-4231
Practice Address - Fax:731-587-6716
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist