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General NPI Number Information
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NPI Number | 1023696416
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Entity Type | Individual
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Provider Name | MICHAEL BRADLEY GALLOWAY OTR/L
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 8845 GARY BURNS DR STE 100
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City | FRISCO
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State | TX
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Zip | 75034-2503
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Country | US
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Telephone | 469-403-2090
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Fax | 469-237-3462
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120566
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License Number State | TX
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