Provider Demographics
NPI:1770391039
Name:GOSHORN, CALLAN MICHELE (OTR/L)
Entity type:Individual
Prefix:
First Name:CALLAN
Middle Name:MICHELE
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CALLAN
Other - Middle Name:MICHELE
Other - Last Name:SHAMBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:570 BENTON CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2300
Mailing Address - Country:US
Mailing Address - Phone:717-579-0969
Mailing Address - Fax:
Practice Address - Street 1:800 KING RUSS RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5101
Practice Address - Country:US
Practice Address - Phone:717-657-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist