Provider Demographics
NPI:1710757778
Name:GALLIMORE, AMY LYNN (OT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GALLIMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:7207 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MACHIPONGO
Mailing Address - State:VA
Mailing Address - Zip Code:23405-1725
Mailing Address - Country:US
Mailing Address - Phone:757-678-5151
Mailing Address - Fax:
Practice Address - Street 1:7207 YOUNG ST
Practice Address - Street 2:
Practice Address - City:MACHIPONGO
Practice Address - State:VA
Practice Address - Zip Code:23405-1725
Practice Address - Country:US
Practice Address - Phone:757-678-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist