Provider Demographics
NPI:1972838290
Name:CALLANAN, JUSTINE MARIE (MED, OTR/L, CEIS)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIE
Last Name:CALLANAN
Suffix:
Gender:F
Credentials:MED, OTR/L, CEIS
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:MARIE
Other - Last Name:PRECOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, OTR/L, CEIS
Mailing Address - Street 1:4 SAMOSET AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2237
Mailing Address - Country:US
Mailing Address - Phone:508-208-8438
Mailing Address - Fax:508-337-8438
Practice Address - Street 1:4 SAMOSET AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2237
Practice Address - Country:US
Practice Address - Phone:508-208-8438
Practice Address - Fax:508-337-8438
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA9995225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist