Provider Demographics
NPI:1982828992
Name:GALLAUGHER, JENNIFER M (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GALLAUGHER
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 1:4118 WILEY LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-6586
Mailing Address - Country:US
Mailing Address - Phone:724-944-7459
Mailing Address - Fax:
Practice Address - Street 1:725 PAUL ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101
Practice Address - Country:US
Practice Address - Phone:724-654-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist