Provider Demographics
NPI:1295384097
Name:GALLEN, KAYLI (MOT,OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:
Last Name:GALLEN
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-1242
Mailing Address - Country:US
Mailing Address - Phone:267-567-2793
Mailing Address - Fax:
Practice Address - Street 1:199 COURT ST
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-8548
Practice Address - Country:US
Practice Address - Phone:304-884-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist