Provider Demographics
NPI:1922743871
Name:BROWN, JESSICA KAITLIN GALLIHAR (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAITLIN GALLIHAR
Last Name:BROWN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GALLIHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2855 FERBER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3008
Mailing Address - Country:US
Mailing Address - Phone:423-620-9035
Mailing Address - Fax:
Practice Address - Street 1:2719 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1145
Practice Address - Country:US
Practice Address - Phone:719-636-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist