Provider Demographics
NPI:1659886364
Name:GALLIK, MEGAN EILEEN (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:EILEEN
Last Name:GALLIK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 2ND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1472
Mailing Address - Country:US
Mailing Address - Phone:570-677-5492
Mailing Address - Fax:
Practice Address - Street 1:516 2ND AVE APT B
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1472
Practice Address - Country:US
Practice Address - Phone:570-677-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist