Provider Demographics
NPI:1003160482
Name:GLAZE, CHABLI
Entity Type:Individual
Prefix:
First Name:CHABLI
Middle Name:
Last Name:GLAZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHABLI
Other - Middle Name:
Other - Last Name:GLAZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8905 NE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-1420
Mailing Address - Country:US
Mailing Address - Phone:405-408-9989
Mailing Address - Fax:
Practice Address - Street 1:8905 NE 51ST ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-1420
Practice Address - Country:US
Practice Address - Phone:405-408-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management