Provider Demographics
NPI:1073779864
Name:GALLAGHER, MARY R (OT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
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Mailing Address - Street 1:3396 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3812
Mailing Address - Country:US
Mailing Address - Phone:203-754-2161
Mailing Address - Fax:203-759-7359
Practice Address - Street 1:230 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1916
Practice Address - Country:US
Practice Address - Phone:860-674-1824
Practice Address - Fax:860-674-1836
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002071225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics