Provider Demographics
NPI:1114401452
Name:KAHL, CALLI (OTR/L)
Entity type:Individual
Prefix:
First Name:CALLI
Middle Name:
Last Name:KAHL
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 1:2517 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-4628
Mailing Address - Country:US
Mailing Address - Phone:563-676-3477
Mailing Address - Fax:
Practice Address - Street 1:2451 CORAL CT STE 1
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2837
Practice Address - Country:US
Practice Address - Phone:319-853-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist