MEDICARE: AUDREY PEIFER GARGIULLO MS, OTR/L

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	225X00000X	Occupational Therapist	OT003455	GA

General Provider Information

NPI Number	:	1972858330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY PEIFER GARGIULLO MS, OTR/L

Provider Business Mailing Address
First Line	:	3911 GLADNEY DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-4600
Country	:	US
Telephone Number	:	770-355-1253
Fax Number	:	404-785-3768

Provider Business Practice Location Address
First Line	:	1001 JOHNSON FERRY RD
Second Line	:	CHIDREN'S HEALTHCARE OF ATLANTA
City	:	ATLANTA
State	:	GA
Zip	:	30342
Country	:	US
Telephone Number	:	404-785-3791
Fax Number	:	404-785-3729

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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