Provider Demographics
NPI:1972858330
Name:GARGIULLO, AUDREY PEIFER (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:PEIFER
Last Name:GARGIULLO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 GLADNEY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4600
Mailing Address - Country:US
Mailing Address - Phone:770-355-1253
Mailing Address - Fax:404-785-3768
Practice Address - Street 1:1001 JOHNSON FERRY RD
Practice Address - Street 2:CHIDREN'S HEALTHCARE OF ATLANTA
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-785-3791
Practice Address - Fax:404-785-3729
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist