Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 359701 | MS |
Y | 225X00000X | Occupational Therapist | OT-3234 | MS |
NPI | 1003341462 |
---|---|
Provider Name | Caley O'callaghan Speck |
First Address | Tupelo, MS 38801-6548 |
Second Address | Tupelo, MS 38801-6548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 16/11/2021 |