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General NPI Number Information
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NPI Number | 1972870814
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Entity Type | Individual
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Provider Name | JACKSON E GALL O.T.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 225 ABRAHAM FLEXNER WAY STE 700
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City | LOUISVILLE
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State | KY
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Zip | 40202-1882
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Country | US
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Telephone | 502-562-0398
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Fax | 502-585-0021
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Provider Business Mailing Address
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Address Line | PO BOX 740041 DEPT 6150
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City | LOUISVILLE
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State | KY
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Zip | 40201-7441
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Country | US
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Telephone | 502-562-0398
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Fax | 502-585-0021
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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 | 31005213A
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License Number State | IN
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