Provider Demographics
NPI:1245624816
Name:GALLINA, JENAE ALEXIS (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENAE
Middle Name:ALEXIS
Last Name:GALLINA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MAKEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3402
Mailing Address - Country:US
Mailing Address - Phone:814-242-5756
Mailing Address - Fax:
Practice Address - Street 1:1225 MAKEN DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3402
Practice Address - Country:US
Practice Address - Phone:814-242-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-22
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation