Provider Demographics
NPI:1609903277
Name:GALLAGHER, LAUREN LABRECQUE (OTR)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LABRECQUE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LAJUREN
Other - Middle Name:V
Other - Last Name:LABRECQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 BRIDGEWATERS DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:732-542-6600
Mailing Address - Fax:732-542-6606
Practice Address - Street 1:15 BRIDGEWATERS DR.
Practice Address - Street 2:SUITE A
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:732-542-6606
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00302900225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics