Provider Demographics
NPI:1164992954
Name:GALCO, ALEXIS NICOLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:NICOLE
Last Name:GALCO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1506
Mailing Address - Country:US
Mailing Address - Phone:419-631-1143
Mailing Address - Fax:
Practice Address - Street 1:32 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1506
Practice Address - Country:US
Practice Address - Phone:419-631-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
OHOTA007398224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant