Active NPI
Theodore Gallagher
- Occupational Therapy Assistant
- Minerva, OH
National Provider Identifier
1770913113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 04743
- Practice address
- 400 Carolyn CT
Minerva, OH 44657-8703 - Phone
- (330) 868-4104
- NPI assigned
- Nov 21, 2013
- Last updated
- Nov 21, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 04743 | OH | Primary |
Addresses
Primary practice location
400 Carolyn CT
Minerva, OH 44657-8703
Mailing address
900 Raff Rd SW
Canton, OH 44710-1560
Phone (330) 327-3087
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04743 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384992000000",
"number": "1770913113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 RAFF RD SW",
"city": "CANTON",
"state": "OH",
"postal_code": "447101560",
"telephone_number": "330-327-3087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 CAROLYN CT",
"city": "MINERVA",
"state": "OH",
"postal_code": "446578703",
"telephone_number": "330-868-4104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLAGHER",
"first_name": "THEODORE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-21",
"last_updated": "2013-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OH",
"license": "04743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minerva, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.