Provider Demographics
NPI:1184748170
Name:GALLAGHER, AMY (OTRL)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32531 N SCOTTSDALE RD
Mailing Address - Street 2:STE 105-162
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-1519
Mailing Address - Country:US
Mailing Address - Phone:480-488-3946
Mailing Address - Fax:480-488-3956
Practice Address - Street 1:32531 N SCOTTSDALE RD
Practice Address - Street 2:STE 105-162
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-1519
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:480-488-3956
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist