Provider Demographics
NPI:1962708370
Name:GALLO, ELYSE (OTR/L)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:GALLO
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:PO BOX 246
Mailing Address - Street 2:SUITE 170, 11 COURT STREET
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0246
Mailing Address - Country:US
Mailing Address - Phone:603-583-4515
Mailing Address - Fax:
Practice Address - Street 1:11 COURT ST
Practice Address - Street 2:SUITE 170
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2745
Practice Address - Country:US
Practice Address - Phone:603-583-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0965225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics