Organization
ACTIVE REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LOUISE GALLATIN OTR (OCCUPATIONAL THERAPIST MEMBER)
(573) 634-7541
Entity
Organization
Contact information
Practice address
2713A INDUSTRIAL DR, JEFFERSON CITY, MO 65109
(573) 634-7541
(573) 634-7543
Mailing address
2713A INDUSTRIAL DR, JEFFERSON CITY, MO 65109
(573) 634-7541
(573) 634-7543
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
000324
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2062395
FIRST HEALTH
MO
01
—
611850
HEALTH LINK
MO
Enumeration date
09/27/2005
Last updated
08/22/2020
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