Provider Demographics
NPI:1700127115
Name:WOODRING, CALLIE JEANNINE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:JEANNINE
Last Name:WOODRING
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 1:1103 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4010
Mailing Address - Country:US
Mailing Address - Phone:910-249-0460
Mailing Address - Fax:
Practice Address - Street 1:1103 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6320
Practice Address - Country:US
Practice Address - Phone:910-249-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12488224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant