Healthcare Provider Details

I. General information

NPI: 1093148660
Provider Name (Legal Business Name): ANGELINE FLORENCE GALLA O.T.R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 08/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 GERMANTOWN AVE
PHILADELPHIA PA
19119-2345
US

IV. Provider business mailing address

865 N 26TH ST # 2
PHILADELPHIA PA
19130-1823
US

V. Phone/Fax

Practice location:
  • Phone: 215-438-5268
  • Fax:
Mailing address:
  • Phone: 310-428-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC012285
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: