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General NPI Number Information
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NPI Number | 1255830808
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Entity Type | Individual
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Provider Name | SARAH L GALLEGOS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 20201 CRAWFORD AVE
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1010
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Country | US
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Telephone | 708-747-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2906 HIGHWAY AVE
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City | HIGHLAND
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State | IN
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Zip | 46322-1631
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Country | US
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Telephone | 219-513-8311
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.004872
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License Number State | IL
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