Provider Demographics
NPI:1205319381
Name:CALLAHAN, ASHLEE BREANNA (COTA)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:BREANNA
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2272
Mailing Address - Country:US
Mailing Address - Phone:605-728-2720
Mailing Address - Fax:
Practice Address - Street 1:3901 W 59TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2272
Practice Address - Country:US
Practice Address - Phone:605-728-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD398A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant