Provider Demographics
NPI:1457380735
Name:ZYCH, ELIZABETH GALLO (OTR L)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GALLO
Last Name:ZYCH
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 COACHMAN DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6554
Mailing Address - Country:US
Mailing Address - Phone:704-846-6640
Mailing Address - Fax:
Practice Address - Street 1:1405 COACHMAN DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6554
Practice Address - Country:US
Practice Address - Phone:704-846-6640
Practice Address - Fax:704-846-6640
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6076225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics