Provider Demographics
NPI:1003499849
Name:GAHAN, DOUGLAS A (OTR/L)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:GAHAN
Suffix:
Gender:M
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 1:206 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3611
Mailing Address - Country:US
Mailing Address - Phone:315-430-6025
Mailing Address - Fax:
Practice Address - Street 1:206 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3611
Practice Address - Country:US
Practice Address - Phone:315-430-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007867-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist