Provider Demographics
NPI:1972278646
Name:GALLEGOS, ERICA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:F
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 1:2944 S TELLER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3565
Mailing Address - Country:US
Mailing Address - Phone:720-291-7598
Mailing Address - Fax:
Practice Address - Street 1:2944 S TELLER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3565
Practice Address - Country:US
Practice Address - Phone:720-291-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist