Individual
JENELLE M GALLARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 S WILBUR AVE, SYRACUSE, NY 13204-2730
(315) 432-0351
(315) 476-7446
Mailing address
607 FERN RD, SYRACUSE, NY 13219-2217
(315) 243-5494
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005838
NY
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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