Provider Demographics
NPI:1881951812
Name:CALLAHAN, JODIE ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:ANN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3053
Mailing Address - Country:US
Mailing Address - Phone:703-451-0452
Mailing Address - Fax:
Practice Address - Street 1:7001A LOISDALE ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3053
Practice Address - Country:US
Practice Address - Phone:703-971-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001236225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics