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General NPI Number Information
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NPI Number | 1194887430
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Entity Type | Individual
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Provider Name | LISA GALLEGO CARLYLE OTR
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 2111 SPRING CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-1297
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Country | US
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Telephone | 561-707-9640
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Fax | 561-557-4415
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Provider Business Mailing Address
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Address Line | 2111 SPRING CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-1297
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Country | US
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Telephone | 561-707-9640
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Fax | 561-557-4415
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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 | OT1522
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License Number State | FL
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