Provider Demographics
NPI:1407990732
Name:GALLAGHER, KAREN ROSE (ATC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ROSE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5524
Mailing Address - Country:US
Mailing Address - Phone:419-297-9962
Mailing Address - Fax:
Practice Address - Street 1:1215 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5524
Practice Address - Country:US
Practice Address - Phone:419-297-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center