Provider Demographics
NPI:1780329557
Name:GAJAN, ELEANOR MARGARET
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARGARET
Last Name:GAJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:MARGARET
Other - Last Name:O'MEILIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1324 E 38TH PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3372
Mailing Address - Country:US
Mailing Address - Phone:918-293-8972
Mailing Address - Fax:
Practice Address - Street 1:5840 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9023
Practice Address - Country:US
Practice Address - Phone:918-699-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
OK5675225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist