Provider Demographics
NPI:1306974076
Name:CALK, PATTI
Entity type:Individual
Prefix:MS
First Name:PATTI
Middle Name:
Last Name:CALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ADCOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269
Mailing Address - Country:US
Mailing Address - Phone:318-728-2467
Mailing Address - Fax:
Practice Address - Street 1:901 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5909
Practice Address - Country:US
Practice Address - Phone:318-387-7817
Practice Address - Fax:318-322-0914
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1318434Medicaid