Provider Demographics
NPI:1912033796
Name:GALLEGO KNOPP, VICTORIA (OT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:GALLEGO KNOPP
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 150TH CT N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-3518
Mailing Address - Country:US
Mailing Address - Phone:561-427-8409
Mailing Address - Fax:561-744-3523
Practice Address - Street 1:11701 150TH CT N
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478-3518
Practice Address - Country:US
Practice Address - Phone:561-427-8409
Practice Address - Fax:561-744-3523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003489OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810672001Medicaid