Provider Demographics
NPI:1013378694
Name:GALLEN, DONNA BUCKLAND (OTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:BUCKLAND
Last Name:GALLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:BUCKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:15739 HEATHERCROFT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8706
Mailing Address - Country:US
Mailing Address - Phone:314-374-7572
Mailing Address - Fax:
Practice Address - Street 1:11960 WESTLINE INDUSTRIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3209
Practice Address - Country:US
Practice Address - Phone:314-819-0480
Practice Address - Fax:314-275-7444
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001026834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist