Provider Demographics
NPI:1396964219
Name:CALLAHAN, KATHLEEN MARIE (COTA L)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4255
Mailing Address - Country:US
Mailing Address - Phone:781-255-0650
Mailing Address - Fax:
Practice Address - Street 1:64 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4255
Practice Address - Country:US
Practice Address - Phone:781-255-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant