Provider Demographics
NPI:1811551385
Name:CALLAGHAN, TEGAN TONSMEIRE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:TONSMEIRE
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TEGAN
Other - Middle Name:ANN
Other - Last Name:TONSMEIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-0168
Mailing Address - Country:US
Mailing Address - Phone:850-588-9641
Mailing Address - Fax:
Practice Address - Street 1:11626 US HIGHWAY 90 STE B
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8927
Practice Address - Country:US
Practice Address - Phone:850-588-9641
Practice Address - Fax:888-711-0441
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3916225X00000X
AL4914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist