Provider Demographics
NPI:1649466178
Name:MCCALLISTER, ANDREA LEA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEA
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:LEA
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO DRAWER 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:479-967-2876
Practice Address - Street 1:502 S HIGHWAY 27
Practice Address - Street 2:SEARAY COUNTY SCHOOL DISTRICT
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-7638
Practice Address - Country:US
Practice Address - Phone:870-448-5976
Practice Address - Fax:870-448-3542
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
234316OtherNBCOT
AR165348721Medicaid