MEDICARE: KRISTEN GALLOWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist
2	225X00000X	Occupational Therapist	OT19865	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043648025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN GALLOWAY

Provider Business Mailing Address
First Line	:	124 STADIUM CT
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3152
Country	:	US
Telephone Number	:	757-651-0183
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 STADIUM CT
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3152
Country	:	US
Telephone Number	:	757-651-0183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	09/10/2019

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Directions to “ KRISTEN GALLOWAY ” Practice Location

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