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General NPI Number Information
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NPI Number | 1669617411
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Entity Type | Individual
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Provider Name | KERIN GALLIVAN-IGO MS
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Gender | Female
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 68 CAMP ST
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City | HYANNIS
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State | MA
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Zip | 02601-3048
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Country | US
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Telephone | 508-775-7026
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Fax | 508-771-0499
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Provider Business Mailing Address
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Address Line | 1 MAGNUSSON CT
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City | EAST SANDWICH
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State | MA
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Zip | 02537-1361
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 313
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License Number State | MA
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