Provider Demographics
NPI:1972870814
Name:GALL, JACKSON E (OT)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:E
Last Name:GALL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740041
Mailing Address - Street 2:DEPT 6150
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-562-0398
Mailing Address - Fax:502-585-0021
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-562-0398
Practice Address - Fax:502-585-0021
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2016-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN31005213A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist