Provider Demographics
NPI:1942430194
Name:CALLINAN, KATELYN
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
Last Name:CALLINAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 RUSSELL ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1822
Mailing Address - Country:US
Mailing Address - Phone:603-781-8672
Mailing Address - Fax:
Practice Address - Street 1:71 RUSSELL ST
Practice Address - Street 2:APT 2
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1822
Practice Address - Country:US
Practice Address - Phone:603-781-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist