Provider Demographics
NPI:1487770988
Name:GALLAGHER, DENISE MARIE (OT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2138
Mailing Address - Country:US
Mailing Address - Phone:641-472-2894
Mailing Address - Fax:641-469-4288
Practice Address - Street 1:400 HIGHLAND ST
Practice Address - Street 2:JEFFERSON COUNTY HOSPITAL
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3713
Practice Address - Country:US
Practice Address - Phone:641-469-4140
Practice Address - Fax:641-469-4288
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist