Provider Demographics
NPI:1104380310
Name:STILTNER, GLENDA ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:ANN
Last Name:STILTNER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 HAND RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-8126
Mailing Address - Country:US
Mailing Address - Phone:276-275-3847
Mailing Address - Fax:
Practice Address - Street 1:1127 HAND RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-8126
Practice Address - Country:US
Practice Address - Phone:276-275-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant