Provider Demographics
NPI:1356683841
Name:GALLAGHER, AMY E (COTA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10969-1323
Mailing Address - Country:US
Mailing Address - Phone:845-981-7020
Mailing Address - Fax:
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:845-431-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10640224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
330067Medicare PIN