Provider Demographics
NPI:1194363283
Name:GALVAN, JAMIE (OTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GALVAN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 W GLENN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2628
Mailing Address - Country:US
Mailing Address - Phone:623-915-0345
Mailing Address - Fax:623-937-5425
Practice Address - Street 1:5430 W GLENN DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2628
Practice Address - Country:US
Practice Address - Phone:623-915-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant