Healthcare Provider Details

I. General information

NPI: 1649471582
Provider Name (Legal Business Name): HOLLY JO GALOW OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S WASHINGTON ST SUITE 101
SPOKANE WA
99204-2608
US

IV. Provider business mailing address

2428 E 40TH AVE
SPOKANE WA
99223-4404
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-7720
  • Fax:
Mailing address:
  • Phone: 509-710-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT00002369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: