=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700469368
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MEGAN SAMANTHA GALLEGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2021
-----------------------------------------------------
Last Update Date | 05/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 ROUTE 306 UNIT 311
-----------------------------------------------------
City | MONSEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10952-1882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-251-3224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 ROUTE 306 UNIT 311
-----------------------------------------------------
City | MONSEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10952-1882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-251-3224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 021798
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------