Lauren Kathleen Calloway, COTA

Individual provider Active NPI Occupational Therapy Assistant · Azle, TX

NPI 1770133993 · NPPES record last updated Sep 19, 2019

Key facts

NPI
1770133993
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
215874 (TX)
Practice address
721 Dunaway LN
Azle, TX 76020-2605
Phone
(817) 444-2536
NPI assigned
Sep 19, 2019
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
215874TXMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 215874 TX Yes

Addresses

Primary practice location

721 Dunaway LN
Azle, TX 76020-2605

Mailing address

1705 SE 11TH St
Mineral Wells, TX 76067-6609
Phone (817) 629-0077

Other providers in Azle, TX

All providers in Azle, TX · Occupational Therapy Assistant in Texas

Sources for this page

Verify at the official NPI Registry.