Provider Demographics
NPI:1417379900
Name:MACCALLUM, KATHRYN MARIE GALLIK (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARIE GALLIK
Last Name:MACCALLUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GALLIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1983 LEGENDARY LN SE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1983 LEGENDARY LN SE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802
Practice Address - Country:US
Practice Address - Phone:509-670-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60279237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist