Provider Demographics
NPI:1043490501
Name:BARDSLEY, GLORIA M (OT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NW 25TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4878
Mailing Address - Country:US
Mailing Address - Phone:508-887-2333
Mailing Address - Fax:
Practice Address - Street 1:1001 NW 25TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4878
Practice Address - Country:US
Practice Address - Phone:508-887-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6704225X00000X
FLOT23204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0700959OtherMASS HEALTH
OT0103OtherBCBS
Y69100Medicare PIN