Provider Demographics
NPI:1750114591
Name:FREELAND, CALLIE DARTLON (LCOTA)
Entity type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:DARTLON
Last Name:FREELAND
Suffix:
Gender:F
Credentials:LCOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8073
Mailing Address - Country:US
Mailing Address - Phone:318-418-5640
Mailing Address - Fax:
Practice Address - Street 1:5445 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-8365
Practice Address - Country:US
Practice Address - Phone:318-428-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325856224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant