Provider Demographics
NPI:1326590696
Name:GALLAGHER, SUZANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:GALLMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39077-0124
Mailing Address - Country:US
Mailing Address - Phone:866-808-4133
Mailing Address - Fax:
Practice Address - Street 1:6030 PARK SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3241
Practice Address - Country:US
Practice Address - Phone:704-909-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8176225X00000X
FLOT24901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist