Provider Demographics
NPI:1326390774
Name:CALLAHAN, DAWN L (COTA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 N JACKSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENS FORK
Mailing Address - State:IN
Mailing Address - Zip Code:47345-9743
Mailing Address - Country:US
Mailing Address - Phone:765-977-4447
Mailing Address - Fax:
Practice Address - Street 1:2401 S L ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7439
Practice Address - Country:US
Practice Address - Phone:765-966-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001571A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant