Provider Demographics
NPI:1124819693
Name:HARLAN, CALLIE MARIE (OTD)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:MARIE
Last Name:HARLAN
Suffix:
Gender:
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-9180
Mailing Address - Country:US
Mailing Address - Phone:864-684-9893
Mailing Address - Fax:
Practice Address - Street 1:123 E MEDICAL LN
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4813
Practice Address - Country:US
Practice Address - Phone:803-791-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program