Provider Demographics
NPI:1851149694
Name:ARDOIN, CALLIE (OTR)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:A
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:3913 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-9435
Mailing Address - Country:US
Mailing Address - Phone:337-201-5905
Mailing Address - Fax:
Practice Address - Street 1:3913 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-9435
Practice Address - Country:US
Practice Address - Phone:337-201-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty