Provider Demographics
NPI:1154830149
Name:GLADDING, ANDREW ST GEORGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ST GEORGE
Last Name:GLADDING
Suffix:
Gender:M
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 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2907
Mailing Address - Country:US
Mailing Address - Phone:404-210-8443
Mailing Address - Fax:
Practice Address - Street 1:200 TABERNACLE RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-7733
Practice Address - Country:US
Practice Address - Phone:828-357-2016
Practice Address - Fax:828-357-1098
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4590225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation