Provider Demographics
NPI:1568348639
Name:GALLOWAY, HEATHER (OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 PINE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2138
Mailing Address - Country:US
Mailing Address - Phone:417-844-2482
Mailing Address - Fax:
Practice Address - Street 1:2690 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262-1816
Practice Address - Country:US
Practice Address - Phone:573-386-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist