Provider Demographics
NPI:1679383673
Name:MASTERS, CALLIE SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:SUE
Last Name:MASTERS
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 1:107 RIDGEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:IA
Mailing Address - Zip Code:50658-9257
Mailing Address - Country:US
Mailing Address - Phone:641-330-6382
Mailing Address - Fax:
Practice Address - Street 1:4319 NW URBANDALE DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7910
Practice Address - Country:US
Practice Address - Phone:515-225-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist