Provider Demographics
NPI:1679016505
Name:ELLYN GATELY, OT, PLLC
Entity type:Organization
Organization Name:ELLYN GATELY, OT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-965-8992
Mailing Address - Street 1:5 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2322
Mailing Address - Country:US
Mailing Address - Phone:631-965-8992
Mailing Address - Fax:
Practice Address - Street 1:5 SALEM CT
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2322
Practice Address - Country:US
Practice Address - Phone:631-965-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty