Individual
MAURIAH GALLOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7615 PLACER RUN, FORT WAYNE, IN 46815-8256
(260) 403-5125
Mailing address
7615 PLACER RUN, FORT WAYNE, IN 46815-8256
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
32002520A
IN
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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