Provider Demographics
NPI:1659012409
Name:GALLEGOS, TAMATHA (MOTR/L, CDRS, CBIS)
Entity Type:Individual
Prefix:
First Name:TAMATHA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MOTR/L, CDRS, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 DOUBLE TREE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3407
Mailing Address - Country:US
Mailing Address - Phone:719-651-8455
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7500
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-5680
Practice Address - Fax:719-526-8883
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007140225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist