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NPI Code Detail

MEDICARE: AUDREY PEIFER GARGIULLO MS, OTR/L

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
1225X00000XOccupational TherapistOT003455GA

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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Directions to “ AUDREY PEIFER GARGIULLO MS, OTR/L” Practice Location

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