Provider Demographics
NPI:1710393434
Name:MCCALLUM, KATHERINE (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 GROUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGWATER
Mailing Address - State:NY
Mailing Address - Zip Code:14560-9714
Mailing Address - Country:US
Mailing Address - Phone:585-749-2635
Mailing Address - Fax:
Practice Address - Street 1:7878 GROUSE RD
Practice Address - Street 2:
Practice Address - City:SPRINGWATER
Practice Address - State:NY
Practice Address - Zip Code:14560-9714
Practice Address - Country:US
Practice Address - Phone:585-749-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist