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NPI Code Detail

MEDICARE: MARYELLEN GALLUN OTR

MEDICARE: MARYELLEN GALLUN OTR
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
1225X00000XOccupational Therapist2901-026WI

Other Identifiers

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

General Provider Information

NPI Number : 1437359262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYELLEN GALLUN OTR
Provider Business Mailing Address
First Line : 677 E STATE ST
Second Line :
City : BURLINGTON
State : WI
Zip : 53105-1639
Country : US
Telephone Number : 262-763-9531
Fax Number :
Provider Business Practice Location Address
First Line : 677 E STATE ST
Second Line :
City : BURLINGTON
State : WI
Zip : 53105-1639
Country : US
Telephone Number : 262-763-9531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2007
Last Update Date : 07/19/2007

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Directions to “ MARYELLEN GALLUN OTR” Practice Location

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