Provider Demographics
NPI:1922652569
Name:GALLOWAY, ELEANOR RAE (OT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:RAE
Last Name:GALLOWAY
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 1:5357 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4440
Mailing Address - Country:US
Mailing Address - Phone:706-416-9760
Mailing Address - Fax:
Practice Address - Street 1:561 E GARDEN DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3148
Practice Address - Country:US
Practice Address - Phone:970-833-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist