Provider Demographics
NPI:1780014332
Name:AGUAYO, GALO E (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:GALO
Middle Name:E
Last Name:AGUAYO
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 BLOOMFIELD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7123
Mailing Address - Country:US
Mailing Address - Phone:973-637-0101
Mailing Address - Fax:
Practice Address - Street 1:1129 BLOOMFIELD AVE STE 210
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7123
Practice Address - Country:US
Practice Address - Phone:973-637-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00621300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist