Provider Demographics
NPI:1013387703
Name:GLOSEMEYER, TALITHA GLORIA (OT/L)
Entity Type:Individual
Prefix:MS
First Name:TALITHA
Middle Name:GLORIA
Last Name:GLOSEMEYER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:MRS
Other - First Name:TALITHA
Other - Middle Name:GLORIA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:2400 W SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2275
Mailing Address - Country:US
Mailing Address - Phone:918-683-0040
Mailing Address - Fax:
Practice Address - Street 1:6127 S JOPLIN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2107
Practice Address - Country:US
Practice Address - Phone:405-503-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT640225X00000X, 225XG0600X, 225XH1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation