Healthcare Provider Details

I. General information

NPI: 1417619099
Provider Name (Legal Business Name): JACQUELINE HELEN GALLAGHER OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 UNIVERSITY EXEC PARK DR STE 825
CHARLOTTE NC
28262-1346
US

IV. Provider business mailing address

8420 UNIVERSITY EXEC PARK DR STE 825
CHARLOTTE NC
28262-1346
US

V. Phone/Fax

Practice location:
  • Phone: 704-727-4830
  • Fax:
Mailing address:
  • Phone: 704-727-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17779
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: