Provider Demographics
NPI:1588937569
Name:GALLAGHER, KAITLIN B (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:B
Last Name:GALLAGHER
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 1:149 ASHBROOK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1204
Mailing Address - Country:US
Mailing Address - Phone:413-244-8798
Mailing Address - Fax:
Practice Address - Street 1:26 SHENIPSIT LAKE RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2332
Practice Address - Country:US
Practice Address - Phone:860-872-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003717225X00000X
MA10521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist