Provider Demographics
NPI:1760147029
Name:WILE, CALLIE (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:WILE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 RIDGEVALE WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5424
Mailing Address - Country:US
Mailing Address - Phone:978-239-6490
Mailing Address - Fax:
Practice Address - Street 1:5211 RIDGEVALE WAY
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5424
Practice Address - Country:US
Practice Address - Phone:978-239-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002519-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist