Provider Demographics
NPI:1083997480
Name:GLENN, MARTHA BESSON (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:BESSON
Last Name:GLENN
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 1:1 UNIVERSITY PL
Mailing Address - Street 2:#21M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4516
Mailing Address - Country:US
Mailing Address - Phone:646-239-6551
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PL
Practice Address - Street 2:#21M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4516
Practice Address - Country:US
Practice Address - Phone:646-239-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011399-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist